Download Results from fourth general population survey on drug use in Ireland

IRELAND
The newsletter of
Ireland’s focal point
to the EMCDDA
Issue 60 | Winter 2017
In this issue
Review on case
management in
addiction services
See pages 15-17
Club Health
2017 conference
in Dublin
Results from fourth
general population
survey on drug use
in Ireland
See page 24
06 Alcohol policy in Ireland
and Scotland
10
Sixth ESPAD survey
12
Psychiatric admissions
13
Substance use
and parenting
18
Naloxone Demonstration
Project
Drugnet Ireland is
produced in collaboration
with the HRB National
Drugs Library. To have
Drugnet Ireland delivered
to your desktop, sign up at
www.drugsandalcohol.ie
L-R: Author of the Evaluation of
the HSE Naloxone Demonstration
Project Dr Ann Eustace, Minister
of State for Communities and
the National Drugs Strategy,
Catherine Byrne TD and HSE
National Director Primary Care
John Hennessy attending the
launch of the report (see p. 18)
The first survey on drug use in the general
population was carried out in Ireland in 2002/3.
The results were jointly published by the National
Advisory Committee on Drugs (NACD), now the
National Advisory Committee on Drugs and
Alcohol (NACDA), and the Drug and Alcohol
Information and Research Unit. The survey was
repeated in 2006/7 and in 2010/11.1 In 2014, the
NACDA commissioned IPSOS MRBI to conduct
the Ireland and Northern Ireland drug prevalence
survey 2014/15.2
Research. Evidence. Action.
Contents
In brief
COVER STORY
Results from fourth general population survey
on illicit drug use in Ireland
1
POLICY AND LEGISLATION
Minimum unit pricing backed by courts in Scotland
6
Alcohol policy in Ireland and Scotland
6
Joint Strategy on the Management of Offenders
7
Responses to UNGASS 2016 8
PREVALENCE AND CURRENT SITUATION
Sixth ESPAD survey report published 10
Trends in alcohol and drug admissions to
psychiatric facilities 12
Young people’s views of substance use
and parenting 13
Second review of quality of crime statistics by CSO
13
RESPONSES
HRB drug and alcohol evidence review on
case management 15
Launch of the Evaluation of the HSE Naloxone
Demonstration Project 18
New psychoactive substances in Europe
conference, Poznan
20
Stop Out of Control Drinking campaign
21
An Garda Síochána Policing Plan 2016 22
Club Health 2017 conference to be held in Dublin 24
SERVICES
Cork and Kerry Alcohol Strategy 2016–2018
25
UPDATES
Recent publications
26
The policy, research and other documents covered
in this issue of Drugnet Ireland have all been retrieved
by the HRB National Drugs Library and may be accessed
on its website www.drugsandalcohol.ie
Developing and implementing effective
responses to the drugs situation requires an
efficient and scientific system of monitoring
so policy-makers can act using sound and
dependable information. Ireland is well
served in terms of the supply of population
data that allows us to develop detailed and
reliable pictures describing the extent and
nature of drug trends over time. Various
health surveillance systems provide the data
on which analysis of the consequences of
problem drug use, and the responses in place
to alleviate or prevent them, can be built.
A number of articles in this issue illustrate the extent
to which policy in Ireland is supported by up-to-date,
robust and comparable data on the drug situation. We
present the main findings from the recently published
2014/15 survey on drug use in the general population,
the fourth iteration of this survey which was first carried
out in 2002/3. The main focus on the findings of general
population studies is on the younger cohorts, and
the information from the general population survey
is complemented by data from several other sources.
Another article presents the findings from the Irish
section of the European School Survey Project on Alcohol
and Other Drugs (ESPAD) that has conducted surveys
of school-going children every four years since 1995.
Findings from general health surveys and longitudinal
studies provide further insight into patterns of behaviour
among the 15–34-years age groups.
Policy-makers and service planners need this monitoring
framework to measure both the overall prevalence
of drug use and of drug dependency and to make
predictions around the demand for services based on
the likely consequences of these prevalence levels. While
such data is essential for the creation of an accurate
picture of the overall drugs situation, effective targeting
of resources, particularly in the demand reduction area,
requires both a broader selection of data sources and
a narrower focus in terms of subject. Recent analysis
of data from the Dunedin Longitudinal Study in New
Zealand demonstrates that the risk factors leading to
greater use of health, social and security services in
adulthood can be identified at a very young age. Details
on personal circumstances combined with demographic
information are clearly associated with a range of health
and behavioural problems, including substance use,
later in life. Creative use of existing datasets will enable
researchers to define these patterns more clearly and
provide information which can be used to help services
to become more targeted and effective.
3
Similarly, last year and last month prevalence of any illegal
drug use has increased since the previous survey; from 7% to
9% and 3% to 5%, respectively. Any illegal drug refers to the
use of cannabis, ecstasy, cocaine powder, magic mushrooms,
amphetamines, poppers, LSD, new psychoactive substances
(NPS), solvents, crack and heroin.
Illicit drug use was more prevalent in males, and was also
greater among young adults, with almost 9% of persons
aged 15–34 years having reported illegal drug use within the
previous month (compared to 5% in 2010/11). Results from the
2014/15 survey indicated that the most commonly used illicit
substances in Ireland, based on last month prevalence, were
cannabis (4%), ecstasy (1%) and cocaine (0.5%).
0
Use of any illegal drug
Cannabis use
Findings revealed that 28% of the population (15–64 years)
had used cannabis at some point in their lives; 8% reported
use in the year prior to the survey; and 4% indicated use in
the preceding month. All of these rates are higher than those
recorded in previous surveys within Ireland (Figure 2).
The proportion of respondents aged 15–64 years who reported
using any illicit drug in their lifetime has increased from 19%
in 2002/3 to almost 31% in 2014/15 (Figure 1). There has also
been an increase when compared to the 2010/11 study (27%).
Figure 1: Lifetime, last year and last month prevalence of any* illicit drug use in Ireland, 2002/3, 2006/7, 2010/11 and 2014/15
45
40
Percentage
35
45
Lifetime
Last year
Last month
30
40
25
35
20
30
15
25
10
20
5
15
0
10
5
0
02/03 06/07
10/11
14/15
02/03 06/07
Adults 15-64 years
10/11
14/15
Males 15-64 years
02/03 06/07
10/11
14/15
Females 15-64 years
02/03 06/07
10/11
14/15
Young adults 15-34 years
18.5
24
27.2
30.7
23.8
29.5
35.5
38.8
13.1
18.6
19
22.6
25.9
31.4
35.7
37.2
5.6
7.2
7
8.9
7.8
9.8
10.4
12.9
3.4
4.7
3.6
4.9
9.8
12.2
12.3
15.7
3
2.9
3.2
4.7
4.1
4.5
5.3
7.1
1.8
1.4
1.1
2.2
5.2
5
5.3
8.5
10/11
14/15
Source: NACDA, 2016
*Any illicit drug refers to the use of cannabis, ecstasy, cocaine powder, magic mushrooms, amphetamines, poppers, LSD, new psychoactive substances, solvents, crack and heroin
Figure 2: Lifetime, last year and last month prevalence of cannabis use in Ireland, 2002/3, 2006/7, 2010/11 and 2014/15
45
40
Percentage
35
30
25
20
15
10
5
0
02/03 06/07
10/11
14/15
02/03 06/07
Adults 15-64 years
Lifetime
Last year
Last month
10/11
14/15
Males 15-64 years
02/03 06/07
10/11
14/15
Females 15-64 years
02/03 06/07
Young adults 15-34 years
17.3
21.9
25.3
27.9
22.2
27.2
33.2
35.8
12.3
16.8
17.5
20
23.8
28.6
33.4
33.5
5.1
6.3
6
7.7
7.2
8.8
9.1
11.2
2.9
3.9
2.9
4.3
8.7
10.6
10.3
13.8
2.6
2.6
2.8
4.4
3.4
4.1
4.7
6.6
1.7
1.2
0.9
2.1
4.3
4.3
4.5
8.1
Source: NACDA, 2016
drugnet IRELAND
The 2014/15 survey followed best practice guidelines
recommended by the European Monitoring Centre for
45 Addiction (EMCDDA). The questionnaire, based
Drugs and Drug
on the European
40 Model Questionnaire, was administered in
face-to-face35
interviews with respondents aged 15+ years.
A sample comprising all households throughout the island of
30
Ireland was randomly selected to participate and fieldwork
25
began in September
2014 and was completed in May 2015. Of
20members contacted, 7005 agreed to take part.
the household
The sample was
15 weighted by gender, age and region to ensure
that it was representative
of the general population. The main
10
measures were lifetime (ever used) use, use in the last year
5
(recent use) and use in the last month (current use).
Issue 60 | Winter 2017
General population survey continued
Issue 60 | Winter 2017
Similar to earlier studies, rates of cannabis use were greater
among men than women: (36% vs 20%) lifetime use; (11%
vs 4%) last year use; and (7% vs 2%) last month use. Since
2002/3, lifetime rates of cannabis use among males have
increased
1612by 61% and last month use by 94%. Lifetime use of
cannabis among females has also increased (20% in 2014/15 vs
1410
12% in 2002/3).
However, last month prevalence in women has
12 8relatively stable over time.
remained
drugnet IRELAND
4
The prevalence
of cannabis use was noticeably higher among
8 6
young adults (15–34 years). Lifetime rates were similar to those
6 4in 2010/11 (34%). Last year and last month prevalence
reported
rates were
4 2 higher than those recorded in the previous survey
(14% vs 10%
and 8% vs 5%), and the proportion of young adults
2
who classified
0 themselves as current users of cannabis has
almost 0doubled since 2002/3. Approximately 13% of males and
6% of females aged 15–34 years indicated that they had used
cannabis in the month prior to the survey. Lifetime, last year
and last month rates of cannabis use among adults aged 35-64
years were 24%, 3% and 2%, respectively.
Cocaine use
Lifetime cocaine use has increased when compared to 2010/11
(Figure 3). The percentage of respondents aged 15–64 years
who reported using cocaine (including crack) at some point
in their lives increased from 7% to 8%. The proportion of
young adults (15–34 years) who reported using cocaine in their
lifetimes has also increased from 9% to 11%.
10
As was observed in previous studies, more men reported using
cocaine in their lifetimes compared to women (11% vs 5%).
However, although the lifetime rate of cocaine use among
persons aged 15–64 years and young adults aged 15–34 years
has more than doubled since 2002/3, the percentage of
respondents reporting current use of cocaine has remained
relatively unchanged across surveys.
Ecstasy use
In Figure 4, significant increases in lifetime and last year
prevalence of ecstasy use were observed in persons aged
15–64 years (7% to 9% and 0.5% to 2%, respectively).
Figure 3: Lifetime, last year and last month prevalence of cocaine use (including crack) in Ireland, 2002/3, 2006/7, 2010/11 and 2014/15
12
10
Percentage
8
6
4
2
0
02/03 06/07
10/11
14/15
02/03 06/07
Adults 15-64 years
Lifetime
Last year
Last month
10/11
14/15
Males 15-64 years
02/03 06/07
10/11
14/15
Females 15-64 years
02/03 06/07
10/11
14/15
Young adults 15-34 years
3
5.3
6.8
7.8
4.3
7.1
9.9
11.1
1.6
3.5
3.8
4.6
4.7
8.2
9.4
1.1
1.7
1.5
1.5
1.7
2.3
2.3
2.6
0.5
1
0.7
0.5
2
3.1
2.8
10.7
2.9
0.4
0.5
0.5
0.5
0.7
0.8
0.8
0.9
0
0.2
0.3
0.2
0.7
1.1
1
0.9
Source: NACDA, 2016
Figure 4: Lifetime, last year and last month prevalence of ecstasy use in Ireland, 2002/3, 2006/7, 2010/11 and 2014/15
16
14
12
10
8
6
4
2
0
02/03 06/07
10/11
14/15
02/03 06/07
Adults 15-64 years
Lifetime
Last year
Last month
Source: NACDA, 2016
10/11
14/15
Males 15-64 years
02/03 06/07
10/11
14/15
Females 15-64 years
02/03 06/07
10/11
14/15
Young adults 15-34 years
3.7
5.5
6.9
9.2
4.9
7.4
10.1
12.9
2.6
3.6
3.7
5.6
7.1
9.1
10.9
14
1.1
1.2
0.5
2.1
1.5
1.8
0.6
3.1
0.6
0.6
0.3
1.1
2.3
2.4
0.9
4.4
0.3
0.3
0.1
1
0.6
0.5
0.1
1.1
0
0.2
0
0.8
0.6
0.6
0.1
2.1
5
the use of cannabis and ecstasy among younger adults, and in
particular young males.
Previous findings from the 2010/11 survey had suggested a
decline in the use of ecstasy among younger Irish adults when
compared to earlier studies. This was possibly due to the
increased use of NPS sold in head shops and online.3
New psychoactive substances (NPS)
In 2014/15, the lifetime prevalence of NPS use among
respondents aged 15–64 years was approximately 4%, while
last month prevalence was less than 1%. In male adults
aged 35-44 years, and those aged 45–54 years, lifetime
prevalence rates were 3% for both. For females, the
corresponding rates were 1.2% and 0.9%, respectively. Last
month prevalence of NPS use for both age categories was
less than 1% in both genders.
1 National Advisory Committee on Drugs (NACD) and Public Health
Information and Research Branch (PHIRB) (2011) Drug use in
Ireland and Northern Ireland: first results from the 2010/11
Drug Prevalence Survey. Bulletin 1. Dublin: NACD and PHIRB.
http://www.drugsandalcohol.ie/16353/
Last year prevalence of NPS use was included as a drug
category for the first time in the 2010/11 NACDA drug
prevalence survey. In contrast to trends observed with other
illicit substances, data from the 2014/15 study demonstrate
a reduction in the use of NPS in the Irish population in both
genders (Figure 5). The percentage of male and female young
adults aged 15–24 years who indicated current use of NPS was
also less than 1%.
2 National Advisory Committee on Drugs (NACDA) and Department
of Health (DoH) UK (2016) Prevalence of Drug Use and Gambling
in Ireland and Drug Use in Northern Ireland. Bulletin 1. Dublin:
NACD and DoH. http://www.drugsandalcohol.ie/26364/
3 Long J (2012) Results from the third general population
survey in Ireland. Drugnet Ireland, 40: 6–8.
http://www.drugsandalcohol.ie/16866/
4 Criminal Justice (Psychoactive Substances) Act 2010.
Available online at http://www.irishstatutebook.ie/eli/2010/
act/22/enacted/en/html
The low prevalence of current NPS use among younger Irish
adults, and decreasing trends in NPS use among respondents
aged 15–64 years of both genders, may be as a result of the
Criminal Justice (Psychoactive Substances) Act 2010, which
came into effect in August 2010. The Act made it an offence,
punishable by up to five years’ imprisonment, to sell or supply
for human consumption substances which are not specifically
proscribed under the Misuse of Drugs Acts, but which have
psychoactive effects.4
5 Kelly A, Carvalho M and Teljeur C (2003) Prevalence of opiate
use in Ireland 2000–2001: a 3-source capture recapture study:
a report to the National Advisory Committee on Drugs SubCommittee on Prevalence. Dublin: Stationery Office.
http://www.drugsandalcohol.ie/5942/
6 Kelly A, Teljeur C and Carvalho M (2009) Prevalence of opiate
use in Ireland 2006: a 3-source capture recapture study: a
report to the National Advisory Committee on Drugs. Dublin:
Stationery Office. http://www.drugsandalcohol.ie/12695/
Nevertheless, despite a decline in the use of NPS, the results
from the 2014/15 survey indicate an increase in the use of illicit
substances within Ireland. This is largely due to an increase in
Figure 5: Last year prevalence of NPS use among adults in Ireland, 2010/11 and 2014/15
8
7
Percentage
8
7
6
5
4
3
2
1
0
Seán Millar
6
5
4
3
2
1
0
10/11
14/15
Adults
15-64 years
Last year
Source: NACDA, 2016
3.5
0.8
10/11
14/15
Males
15-64 years
5.2
1.2
10/11
14/15
Females
15-64 years
1.6
0.5
10/11
14/15
Young adults
15-34 years
6.7
1.6
drugnet IRELAND
Although opioids were included as a drug category in this
study, the prevalence of heroin use was low, as the Ireland and
Northern Ireland drug prevalence survey 2014/15 is a general
population survey. Thus, persons who do not normally reside in
private households have not been included. A national threesource capture-recapture (CRC) study to provide statistically
valid estimates of the prevalence of opiate drug use in the
national population was commissioned by the NACDA and
undertaken in 20015 and 2006.6 The three data sources used
were the Central Treatment List (of clients on methadone), the
Hospital In-Patient Enquiry (HIPE) scheme, and Garda PULSE
data. A third study using the CRC method was commissioned in
2014, and a final report is due to be published shortly.
Issue 60 | Winter 2017
Fourteen per cent of young adults (15–34 years) claimed to
have tried ecstasy at least once in their lifetime, with over 4%
having used it within the last year (vs 0.9% in 2010/11) and 2%
indicating current use (vs 0.1% in 2010/11). Almost 10% of males
and 4% of females aged 15–24 years reported using ecstasy
within the previous year, while current use was 4% (males) and
approximately 3% (females) for the same age category.
drugnet IRELAND
Issue 60 | Winter 2017
6
POLICY AND LEGISLATION
Minimum unit
pricing backed by
courts in Scotland
On 21 October 2016, the Court of Session in Edinburgh ruled
against a challenge to the introduction of minimum unit
pricing (MUP) in Scotland, brought by the Scotch Whisky
Association and others.1 Essentially, the case concerned a
measure (MUP) that the Scottish government argued would
help to reduce alcohol-related harm, while the producers
and sellers of alcohol argued that it inhibited their right by
law to trade freely across the EU.
Central to the judgement in October was the question
whether or not MUP was a proportionate policy under EU law
– in other words, are there more public health benefits to
be achieved by introducing MUP than could be achieved by
other existing policy options, in particular increased taxation
on alcohol? Those opposing MUP argued that changes in
taxation would be a more suitable course of action. However,
in delivering its ruling, the court stated that:
The fundamental problem with an increase in
tax is simply that it does not produce a minimum
price [para. 196] …. The advantage of the proposed
minimum pricing system, so far as protecting health
and life is concerned, is that it is linked to the
strength of the alcohol. Current EU tax arrangements
relate to different types of product (wine, spirits,
beer and cider etc) each of which has a range of
ABVs .… they do not permit taxation of wines at
variable rates according to the strength of alcoholic
content. Minimum pricing permits lower pricing to
be charged for lower strength alcohol [para. 198].1
The Alcohol (Minimum Pricing) (Scotland) Act was passed in
June 2012: 86 members of the Scottish Parliament voted in
its favour, one voted against and 32 abstained. In line with
the Act, the minimum price was to be calculated according
to a formula: MPU × S × V × 100 (minimum price per unit ×
strength of the alcohol × volume of the alcohol in litres). In
2013, Scotland set the MUP at 50p (approx. 55c) – a 70cl bottle
of spirits with an ABV (alcohol by volume) of 40% would retail
at a minimum of £14 (€15.50). This formula and the case for
introducing MUP more broadly were informed by research
conducted by experts from the Sheffield Alcohol Research
Group (SARG) at the University of Sheffield. These experts have
also applied their modelling to the Irish context.2
While the ruling paved the way for the Scottish government
to implement the Act, in November 2016 the Scotch Whisky
Association launched an appeal on the decision to the UK
Supreme Court in London.
Alcohol policy in
Ireland and Scotland
policy discussions. Their second main goal is to promote
evidence-based policies aimed at ‘effectively preventing and
reducing the burden of alcohol’. Based on the World Health
Organization’s strategy, Eurocare’s motto is ‘less is better’.
Skar highlighted that there is no current EU alcohol strategy.
Despite the European Parliament passing a resolution on the
alcohol strategy, she thought it ‘highly doubtful’ that one
would result. However, she described European-level nongovernmental organisation (NGO) collaboration on alcohol as
‘good’ and recommended that they focus on cross-border
issues. She also spoke about alcohol pricing, marketing and
advertising regulations, consumer information, drink driving,
and data gathering and monitoring.
On 2 March 2016, Scottish Health Action on Alcohol Problems
(SHAAP), Alcohol Focus Scotland and Eurocare held a joint
event in Edinburgh to discuss alcohol policy in Scotland
and Ireland. They subsequently published the proceedings
of the event in Alcohol policy in Scotland and Ireland:
European trailblazers or Celtic fringes?1 The event came
about as governments in both countries promoted policies
that focused on increasing the price of alcohol, reducing
its availability, and restricting its marketing. Similarly, both
governments were seen to face sustained opposition from
global alcohol producers in implementing these policies.
The published proceedings contain the five papers presented
on the day and notes from the final discussion session.
‘Europe and alcohol: challenges and
opportunities’, Marian Skar, Eurocare:
The European Alcohol Policy Alliance
Eurocare’s main goal is to raise awareness among EU
decision-makers about the social, health and economic
harms caused by alcohol. They aim to ensure that these
harms are taken into consideration in all relevant EU
Lucy Dillon
1 The full Court of Session judgement is available online
at https://www.scotcourts.gov.uk/search-judgments/
judgment?id=9a1821a7-8980-69d2-b500-ff0000d74aa7
2 For a discussion on the Sheffield research applied to the Irish
context, see Drugnet Ireland, 56, ‘Minimum unit pricing for alcohol:
what will it really mean?’. http://www.drugsandalcohol.ie/25136/
‘Monitoring and evaluating Scotland’s
alcohol strategy (MESAS) 2016: evaluating
Scottish alcohol policy’, Clare Beeston,
NHS Health Scotland
Scotland has a multi-component alcohol strategy that
makes its evaluation difficult. Beeston described the
theory of change approach underpinning the evaluation
and its strengths and weaknesses. She also identified
a number of conclusions that could be drawn from the
evaluation. It found a decline in population consumption
of alcohol between 2009 and 2012, as well as a reduction
in alcohol-related death rates and hospitalisations since
their peak in the mid-2000s. Overall, MESAS found that the
implementation of the alcohol strategy has led to some
7
positive change in intermediate outcomes. However,
Beeston also expressed concern about the finding that
alcohol consumption is flattening and that there has been no
further decline in mortality or morbidity in the last two years.
Douglas described the pattern of alcohol consumption in
Scotland, highlighting the widespread harms experienced
in particular in deprived communities. She argued that in
terms of cost-effectiveness of interventions to reduce
consumption and harm, the three ‘best buys’ were to take
action on alcohol pricing, availability, and marketing. They
were to be seen as mutually reinforcing and should therefore
be implemented ‘collectively’.
Costello described Irish alcohol consumption patterns,
emphasising that ‘binge drinking is a real problem in
Ireland’. Alcohol-related harms were highlighted, including
alcohol-related deaths, and their role in deaths by
suicide in Ireland. Addressing Ireland’s drinking ‘culture’
was described as presenting a particular challenge. As
with previous speakers, she identified alcohol pricing,
availability, consumer information, and advertising and
marketing as requiring action if consumption and harms
were to be addressed. These reflected some of the key
elements of the Public Health (Alcohol) Bill 2015 that was
described, including the use of product labels to contain
a link to a public health website providing information on
alcohol and its related harms. She concluded that at the
time of presenting, the Irish political landscape was ‘much
more favourable to health issues’.
Lucy Dillon
1 Scottish Health Action on Alcohol Problems (2016) Alcohol
policy in Scotland and Ireland: European trailblazers or Celtic
fringes? Edinburgh: Scottish Health Action on Alcohol Problems.
http://www.drugsandalcohol.ie/26101/
Joint Strategy
on the Management
of Offenders
In collaboration with the housing sector, the problem of
finding accommodation for high-risk sex offenders will also
be addressed. Future explorations will examine the viability
of expanding the SORAM model to include other offences.
On 22 September 2016, the Tánaiste and Minister for Justice
and Equality, Frances Fitzgerald TD launched the first Joint
Strategy for the Management of Offenders.1 The strategy,
which builds on existing collaborative work between the
Irish Prison Service (IPS), the Probation Service (PS) and
An Garda Síochána (AGS), highlights two areas, namely the
management of offenders along with a strong focus on
the rights of victims. What follows is an outline of the main
objectives and accompanying actions to go forward between
2016 and 2018.
•
AGS will provide ‘précis of evidence’ nationwide (p. 4) to
assist preparation of pre-sanction reports.
•
Protocols will be agreed by the IPS and PS regarding
confidentiality on the sharing of pre-sanction assessment
reports.
•
Agreements will be made by AGS with the PS and IPS to
allow Gardaí access to information on offenders who are
on probation and in prison.
•
Agencies will ensure that information is shared regarding
prisoners who are unlawfully at large.
More integrated management
It was announced that the Joint Agency Response to
Crime (JARC) would be extended into three more areas:
Dundalk, Waterford City and Limerick City. JARC will
be evaluated to inform future developments and an
online platform E-JARC will be developed to support
communication between agencies. Engagement by the
IPS, the PS and AGS with the Courts Service will aim to
produce shared information technology.
Multi-agency response to management
of sex offenders
The Department of Justice and Equality intends to have the
Sex Offender Risk Assessment and Management (SORAM)
model ratified legally. SORAM will then be officially launched
via a national conference. The research findings of the initial
pilot will inform how SORAM will be implemented nationally.
Sharing good interagency information
The intention is to explore other opportunities for sharing
information among agencies:
Creating more efficient system of
implementing court orders
The PS and AGS will be responsible for outlining a course of
action to deal with cases not meeting the terms of court
orders and warrants issued as a result of non-cooperation.
A system will be created to keep a record of warrants issued
and how they can be retrieved and implemented.
Addressing consequences of domestic
violence in communities
In order to deal with domestic violence, the aim is to develop
stronger ties, common language and understanding between
AGS, the IPS and PS. This will include the use of warning
systems, joint training, and exchanging information on how to
assess and manage offenders.
drugnet IRELAND
‘Whisky galore? Policy challenges and
priorities in Scotland’, Alison Douglas,
chief executive, Alcohol Focus Scotland
‘Finding the right measure? Policy challenges
and priorities in Ireland’, Suzanne Costello,
chief executive, Alcohol Action Ireland
Issue 60 | Winter 2017
Alcohol policy in Ireland
and Scotland continued
drugnet IRELAND
Issue 60 | Winter 2017
8
Joint Strategy on the
Management of Offenders continued
Agencies will continue to work with Tusla to detect and
manage child protection cases and with COSC (the National
Office for the Prevention of Domestic, Sexual and Genderbased Violence) to help support intervention programmes
for offenders of domestic violence.
Benefits of joint training at operational
and management levels
It is proposed that training exchanges will be developed
between AGS, the PS and IPS. Joint training will be
undertaken by these agencies in areas such as domestic
violence, management of sex offenders, and awareness of
radicalisation to violent extremism.
Reintegration and community management
of vulnerable offenders
The IPS and PS will continue to develop the reintegration of
vulnerable prisoners and the Irish Prison Service / Central
Mental Hospital Court diversion programmes. These agencies
will also work with the Health Service Executive to enhance
existing practice protocols.
Advancing North–South cooperation
The intention is to continue the sharing of information
between agencies in Northern Ireland and the Republic. In
addition, agencies will attend the annual Public Protection
Advisory Group seminar to share information with the view
to improving current practice.
Responses to
UNGASS 2016
The United Nations General Assembly Special Session
(UNGASS) on the world drug problem was held in April 2016.
It attracted formal responses from a variety of civil society
bodies working in the area of drug policy. This article looks at
responses from two of these bodies – the International Drug
Policy Consortium (IDPC) and the Global Commission on Drug
Policy (GCDP). UNGASS-related publications by these bodies
were included in earlier issues of Drugnet Ireland, as part of
the ‘Towards UNGASS 2016’ column.1
International Drug Policy Consortium
The IDPC is a global network of 163 NGOs. It focuses on
issues related to drug production, trafficking and use, and
promoting objective and open debate on the effectiveness,
direction and content of drug policies at national and
international levels. The network supports evidence-based
policies that are effective at reducing drug-related harm.2
In September 2016, the IDPC published its version of the
proceedings of the UNGASS.3 The document provides a
summary of each of the sessions held – the plenary and
the five roundtable discussions on: (1) drugs and health;
(2) drugs and crime; (3) cross-cutting issues: drugs and
human rights, youth, women, children and communities;
Protecting victims of crime and upholding
their rights
The PS, IPS, AGS and Department of Justice and Equality will
attend a specially convened meeting that aims to develop a
unified approach to working with victims of crime. A close
working relationship between agencies will ensure that
obligations under the EU Victims Directive are met. The
Victim Service teams of these agencies will collaborate and
develop suitable codes of behaviour for responding to the
rights and needs of victims.
Minister Fitzgerald welcomed ‘the commitment in the
strategy of all three agencies to work together to address
the serious consequences of domestic violence in our
community; this heinous crime in our community can only be
reduced with the dedicated focus outlined in the strategy’.2
Ciara H Guiney
1 Department of Justice and Equality (2016) Joint strategy
on the management of offenders 2016–2018. Dublin:
Department of Justice and Equality. Available online at
http://www.drugsandalcohol.ie/26661/
2 Department of Justice and Equality (2016) Tánaiste launches
Joint Strategy on the Management of Offenders and announces
the extension of Joint Agency (JARC) initiative to Dundalk,
Limerick city and Waterford city. Available online at
http://www.justice.ie/en/JELR/Pages/Extension-of-JointAgency-J-ARC-initiative
(4) new challenges, threats and realities; and (5) drugs and
development. The summaries include a focus on the input of
civil society representatives, and highlight where there was a
lack of consensus between country representatives.
In addition to the summaries, the report provides an overall
critique of the UNGASS process. From the outset, the
IDPC is critical of the central role of the pre-negotiated
UNGASS outcome statement.4 It describes it as having being
negotiated through a process characterised by a ‘lack of
transparency and accountability’. By virtue of the document
having been essentially finalised prior to UNGASS, ‘a number
of barriers were in place to hinder civil society participation.
This all served to ensure that the UNGASS was not the drug
policy revolution that some stakeholders seemed to be
expecting’. The report also describes barriers to civil society
participating at the UNGASS event itself. For example: the
restrictions and censorship placed on their distribution of
literature and reports; and access to sessions being denied
to a significant number of civil society attendees on the day,
despite having previously confirmed attendance. Despite
these barriers, the IDPC argues that ‘the voice of civil
society – including affected populations such as people who
use drugs – was strongly heard at the UNGASS, both in the
preparations and the meeting itself’.
While the report tends to be critical of the UNGASS outcome
statement, the IDPC also concedes that it ‘undoubtedly
takes a step forward from previous commitments [at UN
level] – not least in terms of access to medicines, human
rights, overdose prevention and proportionate sentencing’.
9
continued
In conclusion, the report identified that:
The challenge now for the drug policy reform sector
is to maintain the momentum and attention which
the UNGASS managed to achieve – within the UN,
the media and broader civil society. This requires
a concerted effort to keep the fire burning, rather
than leaving it to burn out and to build on the steps
forward and lessons learned to ensure further
significant shifts in 2019 or 2020 [at the next UN
review of the drug problem].
Global Commission on Drug Policy
The GCDP describes itself as made up of 25 political leaders
and leading thinkers from across the political spectrum.
It sets out to ‘bring to the international level an informed,
science-based discussion about humane and effective
ways to reduce the harm caused by drugs to people and
societies’.5
On the final day of the UNGASS, the GCDP issued a public
statement on the event.6 It described itself as ‘profoundly
disappointed’ with the adopted UNGASS outcome statement.
It argued that:
The document does not acknowledge the
comprehensive failure of the current drug control
regime to reduce drug supply and demand. Nor does
the outcome document account for the damaging
effects of outdated policies on violence and
corruption as well as on population health, human
rights and wellbeing.
The UNGASS outcome statement was perceived to have
sustained ‘an unacceptable and outdated legal status quo’
by reaffirming the three international conventions as ‘the
cornerstone of global drug policy’.
The GCDP identified the outcome document as failing
to recognise the considerable support for change
demonstrated by many governments and civil society
groups, and the ‘many positive drug policy reforms already
underway around the world’. It described as vital that
the tensions between the restrictions imposed by the
international narcotics conventions and ongoing initiatives
on the ground are resolved. In conclusion, it encourages
and supports governments and civil societies in their efforts
‘to fundamentally realign drug policy so that health, citizen
safety and human rights are paramount’.
Lucy Dillon
1 International Drug Policy Consortium:
http://www.drugsandalcohol.ie/25130/; Global Commission
on Drug Policy: http://www.drugsandalcohol.ie/23301/ and
http://www.drugsandalcohol.ie/23684/
2 For more information on the International Drug Policy Consortium,
visit http://idpc.net
3 The United Nations General Assembly Special Session (UNGASS)
on the world drug problem: report of proceedings (2016). IDPC:
London. http://www.drugsandalcohol.ie/26049/
4 As outlined in issue 58 of Drugnet Ireland (http://www.
drugsandalcohol.ie/25954/), two key policy statements to emerge
from the UNGASS process were: the EU common position; and the
UNGASS outcome statement. The UNGASS outcome statement
was agreed by member states at the 59th meeting of the UN
Commission on Narcotic Drugs (CND) in Vienna in March 2016, and
was adopted at the start of the UNGASS.
5 For more information on the Global Commission on Drug Policy,
visit http://www.globalcommissionondrugs.org
6 Public statement by the Global Commission on Drug Policy
on UNGASS 2016 (2016). Available online at http://www.
globalcommissionondrugs.org/wp-content/uploads/2016/04/
FINALpublicstatementforGCDP.pdf
drugnet IRELAND
However, based on other elements of the UNGASS (e.g.
the roundtable and plenary sessions, and inputs from civil
society and country statements), it describes the so-called
‘Vienna Consensus’ (manifest in the outcome document) as
‘irreversibly shattered’ in light of the ‘divergent stances’ of
member states – it described these as ‘impossible to ignore
on key issues such as the death penalty, decriminalisation,
regulated markets and development’.
The GCDP criticised UNGASS for not seriously addressing
what it sees as ‘the critical flaws of international drug policy’,
including the criminalisation of drug users; the use of capital
punishment for drug-related offences; and, the World Health
Organization’s scheduling system of drugs. It also identified
UNGASS as having failed both to advocate for harm reduction
and treatment strategies that have been found to be
effective and to offer proposals to regulate drugs and ‘put
governments – rather than criminals – in control’.
Issue 60 | Winter 2017
Responses to UNGASS 2016
drugnet IRELAND
Issue 60 | Winter 2017
10
PREVALENCE AND CURRENT SITUATION
Sixth ESPAD survey
report published
Table 1: Alcohol use in the past 30 days among
15–16-year-olds in Ireland since 2003
Alcohol use in the
past 30 days
2003
(%)
2007
(%)
2011
(%)
2015
(%)
71
57
48
35
Females
74
56
52
37
All subjects
73
56
50
36
Males
Source: ESPAD Ireland, 2016
The European School Survey Project on Alcohol and Other
Drugs (ESPAD) has conducted surveys of school-going
children every four years since 1995 using a standardised
method and a common questionnaire. The sixth survey
was undertaken in 35 European countries during 2014/15
and collected information on alcohol, tobacco and other
substance use among 15–16-year-old students.
An important goal of the ESPAD survey is to monitor trends
in alcohol consumption, tobacco and other drug use among
15–16-year-olds and to compare trends between countries
and groups of countries. It also provides an opportunity to
observe changes in trends in Ireland over the six waves of
the past 20 years. The rationale for the ESPAD surveys is that
school students are easily accessible and at an age when the
onset of substance use is likely to occur.
This article concentrates on findings from the survey
conducted in Ireland in 2014/15, in which 2036
questionnaires were completed by young people from
50 randomly selected post-primary schools.1 Of these
participants, 1493 were born in 1999 and will be included in
the international ESPAD dataset.
Alcohol use
Respondents were asked on how many occasions in their
lifetime had they used alcohol. Just over one-quarter
(26.4%) answered that they had never consumed an alcoholic
beverage in their lifetime. Overall, 73.6% of students had
drunk alcohol in their lifetime, with almost 20% having tried
alcohol once or twice. Sixteen per cent had drunk alcohol
on more than 20 occasions. Significant gender differences in
lifetime use of alcohol were noted, with more female (75.3%)
than male (72%) respondents having ever consumed alcohol.
Male students, however, were more likely to have tried
alcohol 40 times or more (10.7%) than females (7.5%).
Thirty-six per cent of students had drunk alcohol in the past
30 days and were considered to be current drinkers. Twentyone per cent reported drinking alcohol once or twice in the
past 30 days, while only a small proportion of respondents
had used alcohol 10 times or more (3.4%). Similar to lifetime
use, more female (37.1%) than male (34.9%) students
indicated current alcohol use. Nevertheless, overall, current
alcohol use among students in Ireland has declined (Table 1),
with a 28% reduction since 2011 and a 48% reduction over
the past 20 years.
Respondents who drank alcohol were asked to rate their
level of intoxication. Fourteen per cent of students reported
being drunk in the past 30 days and 40 students reported
being drunk more than once or twice during the past month
(3.0%). A similar number of male (14.7%) and female (13.2%)
students reported being drunk in the past month and
there was no significant difference in mean score on the
drunkenness scale between male (Mean=3.20, SD=1.848) and
female (Mean=3.12, SD=1.742) students.
Beer (28.6%), spirits (24.5%) and cider (21.3%) were the most
common types of alcohol consumed in the month prior to
the survey. The least popular drinks were wine (11.9%) and
alcopops (11.4%). Respondents were asked how difficult they
thought it would be to obtain specific alcoholic beverages,
with response categories ranging from ‘impossible’ to ‘very
easy’. A majority of students believed that it would be fairly
easy to obtain all beverage types examined; 37.8% gave this
answer for beer and 34.7% for cider. A high percentage of
students also said it would be very easy to get beer (31.9%)
or cider (30.2%), while only 5.2% said it would be impossible
to get beer, with 7% reporting that it would be fairly difficult.
Respondents believed that it would be slightly more difficult
to obtain wine and spirits, with a larger number reporting
that it would be fairly or very difficult, and fewer perceiving
that it would be fairly easy or very easy.
Smoking
Participants were asked on how many occasions had they
smoked cigarettes during their lifetimes. More than twothirds of students reported that they had never smoked a
cigarette and a further 10.4% had only smoked on one or two
occasions. Eight per cent of all students reported smoking
on at least 40 occasions. Overall, almost one-third had ever
smoked in their lifetime (32.3%).
When students were asked to consider how often they
smoked in the past 30 days, 87% reported that they had not
smoked at all, while 13% had smoked at least once. Almost
7% of students reported smoking less than one cigarette
per day and a further 5.7% smoked between one and 20
cigarettes per day. Ten students reported smoking more than
20 cigarettes a day. While the proportion of male and female
students who had ever smoked was similar, there were
gender differences in the intensity of smoking behaviours.
More males reported smoking daily and smoking more
cigarettes per day than females, while more female students
smoked less frequently than every day.
Trends over time demonstrate that current smoking among
school-aged children in Ireland is greatly reduced when
compared to previous ESPAD surveys. This represents a
reduction of over two-thirds (68%) since the first survey was
conducted in 1995, and a 38% reduction over the previous
four years (Table 2).
Table 2: Smoking in the past 30 days among
15–16-year-olds in Ireland since 2003
30-day
cigarette use
2003
(%)
2007
(%)
2011
(%)
2015
(%)
Males
28
19
19
13
Females
37
27
23
13
All subjects
33
23
21
13
Source: ESPAD Ireland, 2016
11
Other substance use
Students were asked how many times in their lives had they
used cannabis. Male students (22.4%) were more likely than
females (15.5%) to have ever tried cannabis. Overall, 19% of
students had ever tried cannabis, of which most had tried it
once or twice. There was also a sizeable minority of students
who smoked cannabis 40 times or more (3.9%).
Overall, 16.8% of students had used cannabis in the past 12
months. Again, more male (19.5%) than female respondents
(13.9%) reported using cannabis in the past year. A small
number of males (4.1%) reported using cannabis 40 times
in the past year, suggesting heavier use than female
respondents (1.2%). Boys were also more likely to have tried
cannabis at a younger age than girls. Three per cent of boys
and 1% of girls had first used cannabis at 12 years of age or
younger. Most students had first tried cannabis at 14 years of
age (33%) and 15% had first tried it at 13 years.
When respondents were asked how easy they thought it
would be to obtain cannabis, 41.9% perceived that it would
be impossible, very difficult or fairly difficult and 43.4%
perceived that it would be fairly easy or very easy.
With regard to lifetime use of other substances, after
tobacco, alcohol and cannabis, inhalants were the most
commonly used substance at 10%. The next most regularly
used drugs were painkillers ‘to get high’ (4%), ecstasy (3%)
and tranquilisers (3%). In general, however, the prevalence of
illicit drug use was low.
Trend analysis showed that lifetime use of cannabis in Ireland
and other ESPAD survey countries stayed approximately the
same, with a one-percentage point decrease for the ESPAD
average and a one-percentage point increase for Ireland.
For Ireland, this represents a drop of almost half since 1995,
although lifetime prevalence of cannabis use has remained
relatively unchanged at approximately 20% since 2007 (Table
3). In Ireland, there was an increase in the lifetime use of
illicit drugs other than cannabis by one percentage point,
increasing from 6% to 7%. Overall, however, there has been a
56% reduction since 1995.
Lifetime use
2003
(%)
2007
(%)
2011
(%)
2015
(%)
Cannabis
39
20
18
19
Illicit substances
other than
cannabis
9
10
6
7
Tranquilisers
(prescribed)
10
10
9
11
Tranquilisers
(non-prescribed)
23
3
3
3
Inhalants
18
15
9
10
Magic mushrooms
4
4
2
2
Ecstasy
5
4
2
3
Amphetamines
1
3
2
2
LSD
2
3
2
2
Crack
2
4
2
1
Cocaine
3
4
3
2
Heroin
1
1
1
0.4
Source: ESPAD Ireland, 2016
Current trends
In summary, results from the ESPAD 2015 survey suggest a
decline in the use of alcohol and cigarettes among schoolaged children in the Republic of Ireland. The use of cannabis,
inhalants and other illicit substances may have stabilised,
with an overall reduction over the six data collection waves
from 1995 to 2015. Nevertheless, it should be noted that
early school-leavers, a group known to be vulnerable to
alcohol and drug use, are not represented in this survey.
Consequently, the results may not indicate the true extent of
alcohol and other illicit substance use among all 15–16-yearold children within Ireland.
Seán Millar
1 Taylor K, Babineau K, Keogan S, Whelan E and Clancy L (2016)
ESPAD 2015: European Schools Project on Alcohol and Other
Drugs in Ireland. Dublin: Department of Health. http://www.
drugsandalcohol.ie/26116/
drugnet IRELAND
Over 60% of students perceived obtaining cigarettes as
either fairly easy or very easy, and male students believed
it would be easier to access cigarettes than females. Most
students believed that there is a moderate risk (34%) or a
slight risk (30%) of smoking occasionally, and two-thirds
answered that they perceived a great risk from smoking one
or more packs of cigarettes per day.
Table 3: Percentage of 15–16-year-olds who reported
lifetime use of drugs in the ESPAD Irish surveys of 2003,
2007, 2011 and 2015
Issue 60 | Winter 2017
Sixth ESPAD survey report
published continued
12
50
30
Trends
in alcohol and
20 admissions to
drug
10
psychiatric
facilities
0
Data from Activities of Irish psychiatric units and hospitals
2015, the annual report published by the Mental Health
Information Systems Unit of the Health Research Board, have
shown that the total number of first admissions to inpatient
care for persons with an alcohol disorder has continued to fall.1
In 2015, 1188 cases with an alcohol disorder were admitted
to psychiatric facilities, of whom 437 were treated for the
first time. Figure 1 presents the rates of first admission
between 1995 and 2015. Trends observed since 1995 have
continued, with a reduction in the rate of first admissions
in 2015 compared to 2014. Just over 33% of all cases
hospitalised for an alcohol disorder in 2015 stayed just
under one week, while 28% of cases were hospitalised for
between one and three months.
However, trends of first admissions for alcohol disorders
contrast with those observed for patients with a drug disorder.
Figure 2 presents the rates of first admission between 1995
and 201512
for drug disorder cases. In 2015, 1032 persons were
admitted to psychiatric facilities with a drug disorder. Of these
10 were treated for the first time, which represents
cases, 448
a rate of 9.8 per 100 000 of population, the highest rate
recorded since 1995. Since 2006, there has been a general
increase in the rate of first admissions. It should be noted,
however, that the report does not present data on drug use
and psychiatric comorbidity, so it is not possible to determine
whether or not these admissions were appropriate.
Other notable statistics on admissions for a drug disorder in
2015 include the following:
•
Just under one-half (47.1%) of cases hospitalised for a
drug disorder stayed less than one week, while 98% were
discharged within three months. It should be noted that
admissions and discharges represent episodes or events
and not persons.
•
•
11% of first time admissions were involuntary.
The rate of first time admissions was higher for men
(14.2 per 100 000 of population) than for women
(5.4 per 100 000 of population).
The overall increase in the rate of drug-related first
admissions between 1995 and 2015 may reflect an overall
increase in problem drug use within Ireland, and its
increasing burden on psychiatric and mental health services.
Seán Millar
1 Daly A and Craig S (2016) Activities of Irish psychiatric units and
hospitals 2015. Dublin: Health Research Board. http://www.
drugsandalcohol.ie/25844/
Rate per 100 000 population
8 of psychiatric first admission of cases with an alcohol disorder diagnosis per 100 000 of population in Ireland, 1995–2015
Figure 1: Rates
506
4
40
2
30
0
20
10
0
Rates
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
45
46
41
44
42
41
40
36
31
24
25
20
19
19
16
15
13
11
13
10
9.5
Source: Daly and Craig, 2016
Figure 2: Rates of psychiatric first admission of cases with a drug disorder diagnosis per 100 000 of population in Ireland, 1995–2015
Rate per 100 000 population
drugnet IRELAND
Issue 60 | Winter 2017
40
12
10
8
6
4
2
0
Rates
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
7.5
6.7
6.5
7.2
7.9
7.8
8.4 6.3
6.1
6.7
7.9 5.9 6.3
6.8 7.4
9.7
7.7
7.8
8
8.9 9.8
Source: Daly and Craig, 2016
13
The authors identified three main themes in their analysis
of young people’s views of how family processes can
protect or increase the risk of engaging in drug use:
parent–child attachment; parenting style; and, parent and
sibling substance use. In their discussion, McLaughlin et al.
identified a number of messages for parenting interventions.
These include:
•
Parenting programmes should emphasise ways to
support positive attachments between parent and child.
Second review of
quality of crime
statistics by CSO
In September 2016, the Central Statistics Office (CSO)
published its second review on the accuracy of data collated
on An Garda Síochána’s PULSE (police using leading systems
effectively) system.1 The initial comprehensive review,
published in 2015, was centred on data from 2011.
In Ireland, recorded crime statistics provide vital information
regarding the frequency and type of crime that arises.
However, in 2014, the Garda Inspectorate raised serious
concerns regarding how crime was recorded on PULSE.2
Issues included the non-recording of crimes, lack of
timeliness in recording crimes, misclassifying crime incidents
and non-crime incidents at initial stages, alterations of
narratives, incorrect reclassification of incidents, and
incorrect application of detection and invalidation status
to certain crimes. Seeing that the CSO avails of PULSE data
•
They should teach authoritative parenting styles and
parental monitoring, ensuring participants have the skills
to implement these at home.
•
They should provide parents with the skills necessary
to deal with the discovery or disclosure of substance
use. These skills should include understanding effective
discipline methods and dealing with any conflicts that
might arise.
•
They should generally take account of gender differences
and the role they might play in parents’ ways of
communicating with young people and dealing with any
substance use that may occur. The authors identified a
particular need to work with fathers.
•
They should educate parents about the effects of parental
substance use on their children, while also targeting young
people whose parents were substance users with a schoolbased programme. (Perceptions of the effects of parental
substance use on their children were divided; in some
cases, it was perceived to have a protective effect, while in
others it increased the risk of use.)
The authors concluded that parenting programmes have
a role to play in supporting families to develop the skills
necessary to protect their young people from harm
associated with substance use.
Lucy Dillon
1 McLaughlin A, Campbell A and McColgan M (2016) Adolescent
substance use in the context of the family: a qualitative study of
young people’s views on parent–child attachments, parenting
style and parental substance use. Substance Use & Misuse, 51
(14): 1846–1855. http://www.drugsandalcohol.ie/26088/
to produce crime statistics, it was considered pertinent
to appraise the data received by the CSO to establish how
accurate they were.3 Although publication of crime statistics
restarted following this review, the CSO decided that the
data would need to be monitored on a regular basis. The aim
of the second review was to determine whether issues raised
in the first review still existed.
This analysis essentially retains the same methodology as
the previous study.3 However, there are two exceptions:
sample sizes have been adjusted and the reclassification
section involves a more detailed analysis. Access was
provided by An Garda Síochána to crime and non-crime
data including CAD (command-aided dispatch), paper
records and non-crime PULSE incident groups, incident
narrative audit trails, and reclassified incidents. A random
selection of CAD and paper records was checked against
corresponding records on PULSE.
Non-recording of crimes
In 2015, validated data for crimes (e.g. assault, burglary,
criminal damage, public order, robbery, theft) that occurred
in Dublin and in non-Dublin areas reported on CADs were not
reported on PULSE, 17% and 18% respectively.
drugnet IRELAND
The findings of a qualitative study that sets out to explore
young people’s perceptions of the mechanisms by
which family processes protect or place youth at risk of
substance use have been published. McLaughlin et al.’s1
work was carried out with a view to informing familybased interventions preventing drug use. They held nine
focus groups with a total sample of 62 participants aged
between 13 and 17 years of age. Participants were postprimary school pupils from across Northern Ireland.
While schools were selected from areas with a range of
multiple deprivation measure rankings, data were not
collected on individual pupil’s socioeconomic status or
personal experience of substance misuse. Therefore, the
findings were based on hypothetical situations rather than
participants’ personal experiences. This limitation was
explicitly acknowledged by the authors. Nonetheless, the
findings included some useful insights that can be used to
inform intervention development.
Programmes could educate parents on the importance
of spending ‘quality time’ with their children and support
them in improving their skills for communicating with
their children.
Issue 60 | Winter 2017
Young people’s
views of substance
use and parenting
drugnet IRELAND
Issue 60 | Winter 2017
14
Second review of quality of
crime statistics by CSO continued
In addition, the proportion of validated paper records (16%)
not reported on PULSE were similar to the 2011 analysis.
Matching records was challenging; hence, the authors advised
caution when interpreting results as some records believed
not to be on PULSE may in fact be within the system.
Lack of timeliness in recording crimes
Within the PULSE system a creation date and report date
are recorded. In 2015, the CSO found that following a crime
being reported, there was a delay of over one week before
6% of incidents were recorded on PULSE. Between crime
categories, the delay ranged from a low of 1% (robbery,
extortion and hijacking offences; burglary and related
offences) to a high of 46% of offences against government,
justice procedures, and organisation of crime.
Alteration of narratives
The narrative field on PULSE, which records details of a
crime, can be amended as further information becomes
available. To determine whether narratives had been edited
to justify classification decisions, the narrative lengths of
a random sample of PULSE incident records (n=995) were
analysed to see if any reductions in length had taken place
in 2015, which would indicate unacceptable editing. Four
cases were identified, which was only slightly higher than the
analysis in the previous report (n=1).
Misclassification of incidents
There are approximately 300 crime classifications on PULSE.
Although the majority are crimes, non-crime classifications
also exist (e.g. attention and complaints). How crimes are
classified is essential for accurate reporting. Similar to the
previous analysis, the CSO focused on six classifications
of serious crimes – assault minor; assault causing harm;
criminal damages (not arson); theft from person; burglary;
and robbery from the person. The analysis indicated that 3%
of records were classified incorrectly and the classification
of a further 2% was unclear.
To determine whether non-crime incidents should have
been classified as crimes, narratives from attention and
complaints (n=1200), property lost (n=500) and domestic
dispute (n=300) were examined. Although the majority
of records were classified correctly (95%–98%), a small
number of records were either misclassified (1%–3%) or
unclear (1%–2%). Further analysis indicated that 35 records
from attention and complaints should have been classified
as assaults or fraud/public order offences and one each in
child pornography and robbery; two property lost should
have been in thefts; and six domestic disputes should have
been in assaults or harassment. Nonetheless, the percentage
misclassified had decreased since the 2011 analysis.
Incorrect reclassification of crime incidents
In order to carry out a more in-depth analysis, the CSO
obtained audit trails for all crimes that had been reclassified
by An Garda Síochána in 2015 (n=3500). From these audit
trails, four areas were examined: assault causing harm and
assault minor (n=233), criminal damage (n=224), arson (n=52),
robbery from person or institution (n=28) and burglary
(n=272). The analysis indicated that 68% of reclassifications
were justified, while 32% were not. Reclassifications were
upwards (more serious) or downwards (less serious), 24%
and 48% respectively. Within crime classifications, a higher
percentage of upward reclassifications occurred in the
assault minor category (69%). The highest percentage of
downward reclassifications occurred in the burglary (90%),
arson (87%), assault causing harm (70%) and robbery from
person/institution (61%) categories.
A further analysis of ‘downgrades’ in the burglary category
indicated that 55% were justified and 45% were not.
Primarily, unjustified downgrades in this category were for
reclassifications for attempted burglary to trespassing or
criminal damage categories. Similarly, in the robbery from
person/institution category, 59% were justified and 45%
were not.
In relation to crimes reclassified into non-crime categories,
for example 6% of reclassifications in 2015 were to attention
and complaints, which was lower than the estimate for 2011
(17%). However, the CSO advises caution when interpreting
this result as the samples and methodology may not be
comparable. Notably, three groups – Group 03 Attempts/
threats to murder, assaults, harassments and related
offences; Group 10 Controlled drug offences; and Group 12
Damage to property and to the environment – accounted
for the highest level of reclassifications to attention and
complaints (11%).
Incorrect application of detection status
To determine whether ‘detected’ crimes resulted in criminal
proceedings, 112 879 ‘detected’ crimes were examined.
Sixty-three per cent, which illustrated an increase since
2011 (54%), were linked to a charge or summons, whereas
37% were not. However, the CSO advises caution when
interpreting this, as the 2011 and 2015 data may not be
comparable. A further analysis of the accuracy of ‘detection
rules’ on ‘detected’ crimes with no charge or summons
(n=1000) indicated that nearly one-fifth of crimes were
wrongly assigned ‘detected’ (18%), which was nearly half
of those ‘detected’. This accounted for a 10% (12 789)
reduction in the total number of ‘detected’ crimes.
Incorrect application of invalidation status
Invalidation occurred when there was no crime or when
‘counting rules’ were wrongly applied (p. 28). Out of a sample
of 1000 invalidated records in 2015, 21% were unjustified,
which was slightly lower than 2011 (23%). Importantly, an
unjustified invalidation does not mean a crime has not been
dealt with correctly; often when a new case is created on
PULSE, a previous crime linked to the same case becomes
invalid due to lack of information.
Conclusions and recommendations
The CSO estimated the approximate impact of the problems
identified in their review. The largest percentage changes in
2015 were:
•
Group 13 Public order and other social code
offences (50%)
•
Group 03 Attempts, threats to murder, assaults,
harassments and related offences (33%)
•
Group 12 Damage to property and to the
environment (32%)
•
Group 11 Weapons and explosives offences (31%)
15
Narratives on PULSE need to be more detailed such
that information recorded supports crime classification
applied and any subsequent invalidation/detection
decisions that are made.
Consistent with the Garda Inspectorate report and the
previous analysis in 2011, the analysis carried out by the
CSO on 2015 data illustrates that discrepancies between
crimes recorded on CAD/paper and PULSE are ongoing.
However, although there is evidence of non-recording of
crimes on PULSE, it has to be acknowledged that crime
misclassification on PULSE and inaccurate use of detection
status has reduced since the previous report.
•
To overcome quality issues that were delineated in this
report, it is recommended that An Garda Síochána
should put structures in place to ensure that crimerelated data are monitored and controlled.
The CSO made a number of recommendations to further
improve the quality of crime data.
•
•
•
An area that requires immediate attention is the
CAD narrative field, which should contain all necessary
information about crimes prior to being closed,
including a PULSE identity number (ID), and reasons
for non-recording.
RC1 forms need to be utilised in all non-CAD divisions.
It is vital that Garda stations without an electronic
recording system maintain proper paper records,
including all crime information along with its associated
PULSE record.
With the aim of increasing the reliability of the data, the
CSO continues to collaborate with An Garda Síochána.
Additionally, the CSO intends to continue monitoring
the quality of the data by repeating this analysis on an
ongoing basis.
Ciara H Guiney
1 Central Statistics Office (2016) Review of the quality of crime
statistics 2016. Cork: Central Statistics Office. Available online at:
http://www.drugsandalcohol.ie/26176/
2 Garda Inspectorate (2014) Report of the Garda Síochána
Inspectorate: crime investigation. Dublin: Garda Inspectorate.
Available online at: http://www.drugsandalcohol.ie/22967/
3 Central Statistics Office (2015) Review of the quality of crime
statistics. Dublin: Government of Ireland. Available online at:
http://www.drugsandalcohol.ie/24887/
RESPONSES
HRB drug and alcohol
evidence review on
case management
The objective of the HRB’s recently published scoping
review1 was to examine the peer-reviewed non-experimental
literature on case management and substance use published
between 2003 and 2013, and to answer specific research
questions based on the literature. These comprised
questions on the nature of case management, the outcomes
studied, and gaps in the literature.
In a case management approach to service provision,
clients are typically offered and receive, or are linked to, a
range of services tailored to meet their specific, individual
needs. The objective of linking clients to relevant medical
and social services is a key characteristic of this approach.
Case managers also frequently work as advocates for their
clients. This advocacy work may involve liaising with housing
associations to address accommodation needs or job
centres to improve employability. The rationale behind the
linkage and advocacy work is that clients frequently present
with multiple needs or complications which impact on their
recovery or rehabilitation. Developing and maintaining links
with existing services can help to address these multiple
needs and aid the recovery process. Case management is
also used to increase client retention in services and improve
treatment outcomes.
Case management: models and roles
Vanderplasschen et al. identified six basic models following
their review of the case management literature up to 2003.2
These are outlined briefly below.
•
The brokerage model: Case managers act as ‘brokers’,
assisting clients to identify their needs and gain access to
other services or supports; generally, it involves a brief
engagement with clients with only one or two meetings.
•
Generalist models: Case managers work with clients to
identify needs and negotiate access to required services
and supports; a longer-term and closer relationship with
clients is developed over time.
drugnet IRELAND
•
Issue 60 | Winter 2017
Alterations owing to misclassifications within groups were not
considered; for example, assault causing harm and assault
minor are both in Group 03.
drugnet IRELAND
Issue 60 | Winter 2017
16
Review on case management
continued
•
Assertive community treatment (ACT): Case managers
work in teams to help identify client needs and provide
services directly to clients through assertive outreach.
•
Intensive case management (ICM): Case managers
work on a more intensive, individual basis with clients
and usually have a lower caseload; they identify needs,
provide services directly and link clients with relevant
services.
•
•
The strengths perspective: Case managers seek to
empower the client to identify their own strengths to
build on, rather than primarily focusing on correcting
their deficits; this approach encourages the use of
informal sources of support and help.
Clinical case management: Case managers provide direct
clinical input to clients and combine that with assistance
in accessing other resources, particularly from the health
and social care sector.
In recent years, the role of case management has been
promoted in a number of important policy reports in Ireland,
which include plans to improve service coordination for
people in recovery from substance misuse. In 2007, the
Report of the Working Group on Drugs Rehabilitation3
made a number of key recommendations and set out the
structural arrangements required to implement them. One
of these was the development of broad national protocols
to facilitate interagency working; these cover issues such
as confidentiality, common assessment tools, referral
procedures, and conflict resolution between agencies.
In 2010, the Health Service Executive (HSE) published the
National Drugs Rehabilitation Framework (NDRF), setting out
how services to current and former drug users were to be
provided in the form of supported integrated care pathways
(ICPs) with the cooperation of different service providers.
The report recognised that service users may present with
diverse needs, such as treatment, education, vocational
training, employment support and accommodation, and
that no single agency can cater for all possible needs.
An individual care plan for each service user needs to be
delivered by a multidisciplinary team. Where a service user
has complex and multifaceted needs, a more intensive case
management approach may be used. The framework stated
that the provision of rehabilitation pathways is a shared
responsibility of the education, training and employment
sectors alongside the health, welfare and housing sector,
non-governmental organisations, communities, families, and
the individual themselves.
The ICP comprises four steps, linked to the four-tier model
of service provision: initial contact, involving screening and
referral; initial assessment and identification of appropriate
service; comprehensive assessment, following which a case
manager is identified to support the individual on their
rehabilitation pathway; and implementation of the care plan.
The HRB’s scoping review was commissioned to examine the
non-experimental research literature on case management
and people in recovery from substance misuse. The
objectives of the review were to explore the nature of case
management as reported in the literature, document the
outcomes associated with case management, and identify
the gaps in the research literature. It is hoped that the report
can be used by policy-makers and practitioners in Ireland to
update their understanding and use of case management as
an approach to improving service coordination and recovery.
In order to focus this review, three research questions were
agreed at the outset:
1. What additional knowledge regarding the nature of case
management can be gained from a review of recent nonexperimental research on the topic?
2. What outcomes have been evaluated in the nonexperimental research literature?
3. What are the gaps in the literature?
What additional knowledge regarding the
nature of case management can be gained
from a review of recent non-experimental
research on the topic?
Case management interventions tend to target
clients experiencing extreme disadvantage relative
to other substance misuse treatment clients, with a
disproportionate amount applying to females. The groups
of people being targeted by case management present
with a multitude of personal and social problems, including
substance misuse, homelessness, economic deprivation and
mental health problems.
From the literature reviewed, it would appear that there
are multiple objectives of case management, including
reducing substance misuse and visits to hospital emergency
departments, reducing hospital admissions, and improving
social and psychological functioning. In addition, there are
a number of objectives reported in the literature related to
improving service coordination, such as providing linkages
with medical and social services and retaining people
in treatment. The identification of such a broad range
of objectives points to the multiple needs of the client
base and the expectations on case management as an
intervention.
The review identified a number of features of case
management delivery that were associated with
improved outcomes reported in the evaluations.
These included that duration and intensity of the
intervention could be an important variable to consider
both in future planning and evaluation of case management.
Team-based case management and extensive engagement
by case managers with the client group are also associated
with positive outcomes.
What outcomes have been evaluated in the
non-experimental research literature?
Of the 20 evaluations included in this review, 13 examined
outcomes under the broad heading of psychosocial
functioning, which, after substance use, is the second most
frequent type of indicator in these studies. Two of these
evaluations – one on a combination of ACT and ICM, and the
other on using a community-based case management model
– had a particular focus on quality-of-life issues, and both
studies showed improvements in these outcome domains.
Only three of the 20 evaluation studies in the review did
not find sufficient evidence to support the claim that case
management contributed to improved outcomes in at least
one area. The improved outcomes reported in these studies
may well be associated with the use of case management,
17
What are the gaps in the literature?
The review identified similar gaps in the literature as those
reported by Vanderplasschen et al. As pointed out above,
in the 20 evaluations included in this review, two broad
categories of outcomes were evaluated. The predominant
use of these hard outcomes to evaluate case management
suggests an overemphasis on using case management as
a deficit-reduction intervention. Indeed, there is almost a
complete absence in the literature of the strengths-based
case management model being used and evaluated. This type
of model prioritises the empowerment of the client group by
emphasising their strengths and would be more amenable to
evaluating the softer outcomes that may be associated with
improvements in quality of life.
This review also identified a major gap in the literature
around any attempt to identify what specific aspects of
case management contribute to improved outcomes. In
essence, both primary and secondary studies sought to
determine whether case management works for people in
recovery from substance misuse; in the main these studies
and reviews have produced some evidence to suggest
that case management is an effective intervention to
use with this target group. While such study designs are
important in determining the efficacy and effectiveness of
an intervention, the authors suggest that the evidence base
would also benefit from an evaluation approach that seeks to
understand not only does it work, but for whom and under
what conditions and contexts. They suggest that the realist
approach to evaluation and synthesis may be an appropriate
approach to consider for researchers and reviewers to use in
future investigations of case management.
The authors suggested earlier that certain features of case
management identified in this review – notably the duration,
intensity, the team-based nature of some of the work and
the nature of the engagement between case managers and
clients – could be important variables that require further
elaboration and evaluation. Although their observations are
based on a small number of studies, the authors reiterate
the point here and suggest that these features and perhaps
many more could be investigated using the realist approach.
The realist approach is a theory-driven approach to
evaluation and synthesis; it seeks to uncover the processes
or mechanisms that lead to particular outcomes, and the
context within which this occurs.
It could well be hypothesised that engagement is also a
key mechanism that is associated with improved outcomes
in clients of case management, for example, when the
intervention is intensive, of longer duration, accompanied by
a good working alliance between the case manager and client
and with dedicated care plans. These components could
well contribute to the client engaging with the intervention
and ‘investing’ in their recovery and accruing some benefits.
Further evaluation and synthesis of case management with
people in recovery from substance misuse are needed
to investigate the role of these potential features of case
management in delivering improved outcomes for clients.
Brian Galvin
1 Nic Gabhainn S, D’Eath M, Keane M and Sixsmith JA (2016)
Scoping review of case management in the treatment
of drug and alcohol misuse, 2003–2013. HRB Drug and
Alcohol Evidence Review 3. Dublin: Health Research Board.
http://www.drugsandalcohol.ie/26681/
2 Vanderplasschen W, Wolf J, Rapp RC and Broekaert E (2007)
Effectiveness of different models of case management for
substance-abusing populations. Journal of Psychoactive Drugs,
39(1): 81–95.
3 Working Group on Drugs Rehabilitation (2007) National
Drugs Strategy 2001–2008: rehabilitation. Report of the
Working Group on Drugs Rehabilitation, May 2007. Dublin:
Department of Community, Rural and Gaeltacht Affairs.
http://www.drugsandalcohol.ie/6267/
4 Jackson LA, Buxton JA, Dingwell J, Dykeman M, Gahagan J,
Gallant K, Karabanow J, Kirkland S, LeVangie D, Sketris I, Gossop
M and Davison C (2014) Improving psychosocial health and
employment outcomes for individuals receiving methadone
treatment: a realist synthesis of what makes interventions work.
BMC Psychology, 2(1): 26.
drugnet IRELAND
Vanderplasschen et al. argue that there is a need to consider
outcomes beyond drug use and other ‘socially acceptable
outcomes’ and to take into account quality-of-life outcomes
and clients’ subjective perceptions when evaluating the
effectiveness of case management. They also noted that
there is little information on the crucial features of case
management and what specific aspects of this intervention
contribute to specific outcomes. This is exacerbated by the
lack of fidelity in implementation and the distance between
the model chosen and its practical application.
A recent review in 2014 by Jackson et al.4 provides a
useful example on how the realist approach may elucidate
important learning about case management in future
investigations.4 This is a realist review and the methods
used enabled the authors to draw certain conclusions
about why an intervention may work sometimes and under
what conditions. Its exploration of the literature in the area
suggests that engagement with an intervention appears to be
key to its success.
Issue 60 | Winter 2017
or they may be due to unknown factors or influences which
cannot be ruled out given the design of the evaluations
reported. Only one-quarter of the evaluation studies used
a comparison group; the rest of the evaluation studies used
retrospective single groups and before-and-after designs.
drugnet IRELAND
Issue 60 | Winter 2017
18
Launch of the
Evaluation of the
HSE Naloxone
Demonstration
Project
On 30 August 2016, Minister of State for Communities and
National Drugs Strategy Catherine Byrne TD attended the
launch of the Evaluation of the HSE Naloxone Demonstration
Project in Temple Bar, Dublin.1 The external evaluation was
commissioned by the HSE National Social Inclusion Office
and its launch coincided with International Overdose Day.
The key theme was ‘Time to Remember, Time to Act’, which
acknowledged the trauma and suffering of families and friends
affected by drug misuse. The aim of the day was to reduce the
stigma of drug-related deaths and to spread the message that
overdose death and injury is preventable.
Background
In Europe, between 6000 and 8000 deaths by overdose are
reported annually with the majority as a result of heroin or
opiate overdose.2 In Ireland, based on figures reported in the
National Drug-Related Deaths Index (NDRDI) for 2013, opioids
were implicated in 203 deaths, representing 58.2% of the total
number of poisonings that year.3 A principle finding in this data
was that 42% of these individuals were not alone at the time
of death. This indicated that an appropriate intervention, such
as the administration of an opioid reversal agent like naloxone,
could have potentially saved those lives.
Naloxone is a semi-synthetic drug used to temporarily
alleviate the physiological symptoms of opiate overdose. It is
listed by the World Health Organization as a specific antidote
and was included on the Model list of essential medicines
in 2013.4 Administered intravenously, intramuscularly or by
nasal spray, naloxone temporarily reverses the respiratory
depression experienced during an overdose, providing a lifesaving period before emergency services arrive for further
medical intervention.
Naloxone Demonstration Project
Under Action 40 of the current National Drugs Strategy and
addressing the four tiers of the Rehabilitation Pathway of the
National Drugs Rehabilitation Implementation Committee
(NDRIC),5,6 the purpose of the HSE Naloxone Demonstration
Project was to test the feasibility of making naloxone
available to prevent death from overdose. The first part of
the project involved formal briefing and training of drug
users and those close to them (including service providers,
front-line workers, family members, and friends) on how to
use naloxone and how to recognise and manage overdose
events. The second part involved prescribing naloxone kits
to 600 opioid users in Dublin, Limerick, Cork and Waterford
following training. The naloxone kits were single, individual
use prepacked syringes containing five doses of Prenoxad®
(1 mg/ml injection). Intramuscular administration of naloxone
was used as no intranasal device has yet been approved for
the European market.
Over a two-year preparatory period, a quality advisory group
(QAG) was established to oversee the implementation of the
project and extensive input was sought from a number of
different stakeholders.7 A cascade-style training model for the
project was agreed and comprehensive training materials and
resources were developed. The project formally commenced in
February 2015 and the external evaluation began in June 2015,
involving action research which continued until October 2015.
A process evaluation was carried out to analyse the content
and quality of the training programme, and to gather feedback
from training participants. In addition, an outcome evaluation
of the training was conducted, and the effect of the practical
application of naloxone and harm-minimising techniques to
reduce the number of fatal overdoses was investigated.
An open invitation was sent to all relevant services to take
part in the naloxone and overdose training alongside the
implementation of a programme to increase awareness of the
project in potentially interested stakeholders, e.g. homeless
services, National Family Support Network (NFSN). Thirty-one
people took part in a train-the-trainer programme, one-third
of whom cascaded the training programme across the four
demonstration sites. By October 2015, close to 600 people
had received the naloxone and overdose training, comprising
a diverse group of general practitioners (GPs), pharmacists,
front-line workers, HSE and Irish Prison Service personnel,
opioid users, family members and outreach workers.
Attending the launch of the Evaluation of
the HSE Naloxone Demonstration Project,
Mr Tim Bingham and Minister of State
for Communities and the National Drugs
Strategy, Catherine Byrne TD
19
Results of evaluation
Post-overdose event interviews were conducted, which showed
that those who administered the naloxone felt pride and relief in
their contribution to saving a life. Being armed with a tool to use
in the event of an overdose situation provided these individuals
with increased confidence and a sense of empowerment.
Although four demonstration sites were initially included in the
project, no prescriptions were issued in Cork. The factors which
improved uptake in the other demonstration sites were listed as
increased prior knowledge of and interaction with the project;
availability of local champions; belief in the efficacy of naloxone;
clear communication of the process and referral pathways;
acceptance, willingness and availability of GPs locally to engage
and prescribe naloxone from the outset; and support from the
NFSN and its membership on the ground.
Recommendations
The evaluation recommended the national implementation of
the demonstration project in a managed, phased and strategic
manner. This process will demand intense logistical coordination
and specific areas of the project will require revision and
reworking. The evaluation provided six key recommendations
centred on ‘communication, consultation, training design,
robust research and planning for future roll out and distribution
of naloxone in Ireland’ (p. 57).1
1
Improved communication is required on a national level.
Feedback should be given adequate consideration in
advance of an all-Ireland rollout of the scheme.
2 The governance of the QAG should be strengthened and
membership extended to include clinical expertise and
regional representation.
5 The briefing of opioid users, family members, friends
and front-line workers should be continually monitored
carefully and supported. In particular, the opioid users
receiving the naloxone prescriptions should be given
special attention, where health, well-being and drugrelated behaviour are tracked over time.
6 Multidisciplinary research with a focus on clinical
governance should take place relating to naloxone in
Ireland. This research should be overseen by the QAG.
In terms of health economics, the project represented
a good return on investment (€62,500) for the HSE. The
demonstration project was responsible for the widespread
training of opioid users, service providers and a wide range
of other organisations about the threat of overdose and the
potential of naloxone to save lives.
It has removed some of the stigma associated with drug
misuse and provided people with a powerful life-saving,
harm-minimising tool for use in overdose situations.
The evaluation highlighted the positive effects of naloxone as a
‘catalyst for positive change in behaviour in drug use and harm
minimisation’ (p. 52). The authors felt that the demonstration
project was well received in Ireland among the family members
and front-line workers, and was deemed a success. In addition,
given the approval of an intranasal formulation of naloxone by
the US Food and Drug Administration in 2015, it is possible that
the use of this device may be incorporated into new legislation
in Ireland once a European equivalent becomes available.
Thérése Lynn
1 Clarke A and Eustace A (2016) External evaluation of the HSE
Naloxone Demonstration Project. Dublin: Health Service Executive
(HSE). http://www.drugsandalcohol.ie/26037/
2 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
(2015) European Drug Report 2015: trends and developments.
Luxembourg: Publications Office of the European Union.
http://www.drugsandalcohol.ie/24029/
3 Health Research Board (2015) Drug-related deaths and deaths
among drug users in Ireland: 2013 figures from the National DrugRelated Deaths Index. Dublin: Health Research Board.
http://www.drugsandalcohol.ie/24676/
4 World Health Organization (WHO) (2013) WHO model list of essential
medicines. 18th edn. http://www.who.int/medicines/publications/
essentialmedicines/en/
5 Department of Community, Rural and Gaeltacht Affairs (2009)
National Drugs Strategy (interim) 2009–2016. Dublin: Department of
Community, Rural and Gaeltacht Affairs. http://www.drugsandalcohol.
ie/12388/
6 Department of Community, Rural and Gaeltacht Affairs (2007) National
Drugs Strategy 2001–2008: rehabilitation. Dublin: Department of
Community, Rural and Gaeltacht Affairs. http://www.drugsandalcohol.
ie/6267/
3 Naloxone should be rolled out in Ireland in a measured,
phased and strategic manner with a focus primarily on the
Waterford/South East and Cork region. Dedicated staff and
resources should be assigned to coordinate this process
efficiently.
7 Consultation took place with ‘key stakeholders within the Department
of Health, Health Products Regulatory Authority (HPRA), National
Family Support Network (NFSN), voluntary support network, Irish
Prison Service (IPS), Ana Liffey Drug Project (ALDP), Merchants Quay
Ireland (MQI), National Drugs Rehabilitation Implementation Committee
(NDRIC), SafetyNet, Primary Care, Pre-Hospital Emergency Care
Council (PHECC) and the HSE Addiction Services’. (p. 27).
4 The training programme should be accredited by an
appropriate body and should incorporate the learning
8 A further three overdose events and naloxone administrations
occurred between November 2015 and January 2016.
drugnet IRELAND
Each participant completed a survey before and after
the training. The results revealed significantly increased
understanding and awareness of how to recognise and manage
an opioid overdose event and the steps taken to administer
naloxone appropriately. In total, 95 naloxone prescriptions
were issued during the project by six GPs; the majority (67%)
of prescriptions were in Dublin and the remainder (33%) in
Limerick. As the project ended, another GP began prescribing
naloxone in Waterford, as did the Drug Treatment Programme
in the Irish Prison Service at Mountjoy Prison, Dublin. There
were five separate overdoses during the project and in each
case naloxone was administered in accordance with the
predefined procedure. Four of these administrations were
carried out by a front-line worker and the fifth was peer-topeer. Notably, each naloxone kit was administered to a person
other than for whom it had been prescribed. The evaluation
found that the project successfully minimised the number of
potentially fatal overdoses in Ireland between February and
October 20158 and concluded that widespread accessibility
and availability of naloxone was crucial to its life-saving
function in the community.
from the evaluation. In addition, the programme should
be flexible and constantly evolving to incorporate future
feedback from participants, changes in legislation and
product availability.
Issue 60 | Winter 2017
HSE Naloxone
Demonstration Project continued
drugnet IRELAND
Issue 60 | Winter 2017
20
New psychoactive
substances in Europe
conference, Poznan
On 26–27 October 2016, the Polish Reitox Focal Point and
National Bureau for Drug Prevention held a conference on
new psychoactive substances (NPS) in Europe. The conference
opened with an overview of EMCDDA and the EU Early Warning
System (EWS), which monitors and responds to new drugs
or trends in drug use. Information is fed into the EU EWS by
national focal points; this information exchange can trigger
the preparation of joint reports and a formal risk assessment
process followed by control measures as required.
There have been over 600 NPS notified to the EMCDDA and,
of these, approximately two-thirds have been notified since
2012. The biggest group of NPS is synthetic cannabinoids
followed by cathinones. Synthetic benzodiazepines and
synthetic opioids have recently emerged, including extremely
potent synthetic fentanyls. There is no sign of a decrease in
this flow of new drugs with 98 new psychoactive substances
reported in 2015. While approximately 250 of these drugs are
internationally controlled, the rest are not.
‘Chasing the white rabbit’
The analogy ‘chasing the white rabbit’ described a common
theme throughout many presentations, namely, legislation
introduced to ban NPS has driven the production of
new substances, some worse than the originally banned
substances. While ‘brick and mortar’ shops selling NPS have
been largely eliminated, the market has simply moved online.
Chinese manufacturers of NPS are reportedly capable of
creating any drug upon request, including providing the
precursor if desired, packaging and describing the product
in any way requested, and advising on additional protective
measures and new ways to transport.
The 2016 EU drug markets report states that:
Globalised supply chains and the internet play
a major role in driving the availability of new
substances in Europe. Underpinning this growth is
the ability to order bulk quantities of new substances
from companies in China and to transport them
rapidly to Europe by air or sea. Actors in the EU then
package and market them either on the open market
or directly on the illicit drug market.1
The near-impossible task of stemming the flow of NPS
in the current globalised world was highlighted by Polish
Customs officials, citing the enormous volumes of imports
annually, extensive borders, increased flights, increased
shipments, and millions of Customs declarations (often
impossible to decipher). Misdeclarations are also common.
The huge variety of NPS drugs and the rapid emergence of
replacements when substances are banned cause difficulties
in securing convictions for police across Europe, especially
since a seizure may, after analysis, prove to be a noncontrolled substance. Sanctions for the production and
trafficking in NPS available to authorities in Poland include
financial and administrative as well as penal sanctions.
Risk assessment and safety
At EU level, scientific risk assessment is separated from
political decision; however; it is not possible to deal with
the current numbers of NPS through this system and a
three-stage assessment process is being progressed. The
use of precautionary-based policies, adopted in a number
of countries, as opposed to evidence-based policies (risk
assessment) was discussed, posing the question ‘Are we
doing the right thing?’
Information about safe doses and risks associated with
NPS should be provided to NPS users as a harm reduction
measure. Also, medical staff need to be better informed
so they can best treat emergencies. The EMCDDA
recommended the development of hospital emergencies
data as an instrument to be included in routine reporting.2
In Poland, medical staff are required to report all NPS
intoxications centrally, and this information is submitted
to the Ministry of Health. Collated data can quickly alert
authorities to dangers, such as the introduction of a new
substance on the market. The health indicator monitored in
Poland is medical interventions per 100 000, which reached
7284 in 2015, including 1627 in the 16–18 years age group and
2817 in the 19–24 years age group. The highest users of NPS
are 19–24-year-olds (who were initially exposed to these
substances as teenagers from 2008 onwards).
Peaks in intoxications occurred prior to planned legislative
changes, when suppliers offered sales and promotions
on products about to be banned. Suppliers immediately
responded to bans with a range of new substances and
promotions, such as offering free samples as ‘testers’. In
Poland, deaths attributed to NPS increased from 3 in 2013 to
22 in 2015. In Estonia, the main problem drugs are fentanyls
(in Talinn) and amphetamines (in Narva). Drug-related deaths
in Estonia decreased from 170 in 2012 to 88 in 2015. This is
attributed to the naloxone programme introduced in 2013;
1336 personnel have been trained in the use of naloxone to
treat opioid overdose, including 1054 drug users.
Research and information gathering
The need for better ways to monitor and gain insight and
understanding of NPS users was advocated throughout
the conference. This is regarded as essential in order to
elucidate the attraction of these drugs and thereby help
prevent social harm. Different aspects of information
gathered by the I-TREND project carried out in several
European countries were described.3 This multifaceted
project included:
•
Automated analysis of online shops using a prototype
software acting as a ‘robot’ trawling forums4
•
Purchase and analysis of NPS online (The most reliable
sources for online purchase were in the UK.)
•
Survey of online users to identify motivations of NPS
users and circumstances of use
•
Analysis of national preferences
The survey of online NPS users found 72% were males aged
15–24 years, most were in education, living in cities and
polydrug users. The reason(s) for taking these drugs included
to socialise (53%), get high (51%), modify perception (47.5%),
relax (32.5%), and personal curiosity (44.5%).
21
methods, investigation of fast screening with handheld
device and electronic repository of nitrogen/phosphorus
detector data.
A challenge in compiling and sharing data is that chemical
data are formatted differently in various databases with
a wide range of vendor-specific formats for each drug,
proprietary spectra formats, and complex data streams.
There is also a need for a unique way to unambiguously
name compounds, as current systematic chemical naming
protocols can give several variants to the same molecule.
The need for a change of attitude towards drug users
was also advocated. It was argued that since it will never
be possible to reduce drug use to zero, rather than
penalising users, a better approach would be to promote
a healthy lifestyle in the same way that alcohol and tobacco
use are addressed.
Siobhan Stokes
Collaboration and sharing of analytical
information
Collaboration and sharing of analytical information
was the final theme explored. European data-sharing
initiatives include:
•
EMCDDA’s European Database on New Drugs (EDND):
This is under redevelopment to improve information and
searchability of the database. A pilot will launch in 2017.
•
EU Joint Research Centre Directorate: Cloud
spectroscopy for identification and monitoring of new
psychoactive substances aims to provide fast recognition
of NPS5 and unknown chemicals, harmonised analytical
Stop Out of Control
Drinking campaign
The Diageo-funded ‘responsible drinking’ campaign named
Stop Out of Control Drinking (SOOCD) was launched in
February 2015 and chaired by Fergus Finlay, the chief
executive of Barnardos. Since its inception, it has generated
controversy due to its funding by the alcohol industry, and it
has been claimed that it is merely a smokescreen to take away
political focus from reforms in the Public Health (Alcohol) Bill
2015 around minimum pricing, marketing, alcohol promotion
and alcohol availability.1 A recent study analysed the SOOCD
campaign. Its aims were to identify how the campaign and its
advisory board members frame and define alcohol-related
harm and its causes, and possible solutions.2 This involved
undertaking an analysis of SOOCD campaign material, which
included newspaper articles (n=9), media interviews (n=11),
Facebook posts (n=92), and Twitter tweets (n=340) produced
by the campaign and by board members.
SOOCD board members
Initially, there were 17 board members, although four
subsequently resigned, including David Smith, Diageo Ireland
country director. A number of the remaining board members
or their organisations have links to Diageo/Guinness. Gavin
Duffy worked as an alcohol industry consultant and for
Guinness; Sport for Business has Guinness as a client; Dublin
City University has received Diageo funding; the Irish Rugby
1 European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) (2016) EU drug markets report. Luxembourg:
Publications Office of the European Union. http://www.
drugsandalcohol.ie/25357/
2 EMCDDA (2016) 2016–18 strategy and work programme and 2016
annual work programme. Available online at http://www.emcdda.
europa.eu/publications/work-programmes-and-strategies/2016work-programme
3 For more information on I-TREND, visit http://www.i-trend.eu/
4 Open source software is available online at https://github.com/ITREND/SASF
5 European Commission (2016) Fostering the detection of
‘legal highs’. Available online at https://ec.europa.eu/jrc/en/
news/fostering-detection-legal-highs; Systematic analytical
characterization of new psychoactive substances: a case study.
Available online at https://ec.europa.eu/jrc/en/publication/
systematic-analytical-characterization-new-psychoactivesubstances-case-study
Union Players Association (IRUPA) is sponsored by Diageo;
and Fergus Finlay is a mentor to the Arthur Guinness Fund
supporting social entrepreneurs. It was not possible to
ascertain if board members had any links to other alcohol
companies. The campaign itself was supported by public
relations firm Goddard Global, which has had both Diageo
and tobacco companies as clients and is linked to the
Common Sense Alliance, a tobacco industry lobby group.
Framing the problem
Although the campaign focuses on ‘out of control drinking’,
what this means is not clearly defined. The authors found
that the campaign used vague or self-defined concepts of
‘out of control’ and ‘moderate’ drinking, presenting alcohol
harm as a behavioural problem rather than a health issue.
There was no attempt to quantify moderate drinking, while
one board member described the internationally public
health measure of binge drinking as being ‘unhelpful’. Some
board members stated that moderate drinking is normal, and
identified not drinking as abnormal; several also stated that
critics of the campaign are non-drinkers and prohibitionists.
In relation to alcohol-related harm, the campaign emphasised
antisocial behaviour; in contrast, the health harms associated
with alcohol were almost entirely absent from discussions,
even though alcohol-related health harm in Ireland is
considerable. The focus was on young people, particularly
young women, despite alcohol harms affecting men, women
and children across the whole population. It was the opinion of
the board members that the main causes of excessive drinking
in young people were individual attitudes and motivations; Irish
culture, tradition and society; and peers and parents.
drugnet IRELAND
Further research was presented based on analysis of
1 281 660 posts from internet forums identifying the
motivation of users, the context of NPS use (where used
and with whom), substance trajectories, and characteristics
of users. NPS users were then categorised as six different
types: scientist experts; experimenters; kami-kase cyborgs;
novices; superman; or partygoers.
Issue 60 | Winter 2017
New psychoactive substances
conference continued
drugnet IRELAND
Issue 60 | Winter 2017
22
Stop Out of Control Drinking
campaign continued
They also highlighted that it is individuals themselves that are
responsible for creating the Irish drinking culture, and they
appeared to absolve the alcohol industry of any responsibility
towards the creation or maintenance of this culture. In some
cases, the responsibility of industry is explicitly excluded as an
influence by board members.
Framing the solutions to ‘out of control
drinking’
Similar to the alcohol industry, board members focused on
dealing with alcohol misuse, particularly in young people,
rather than looking at alcohol as an issue for the general
population. Board members generally did not recommend
evidence-based population-based approaches, such as
alcohol marketing restrictions, minimum unit pricing, and
restrictions on availability. Conversely, they placed strong
emphasis on educational interventions which are widely
accepted as being ineffective. The need for evidence in dealing
with the problem of ‘out of control’ drinking is mentioned,
but scientific evidence is just one aspect to be considered
alongside views, conversations, stories and experiences.
An Garda Síochána
Policing Plan 2016
An Garda Síochána Policing Plan 2016 identifies the policing
commitments for 2016.1 The focus of the plan is to protect
communities and individuals in Ireland from risk and harm
connected with crime, drugs, and domestic-related crime
(e.g. burglaries and domestic violence). A number of areas
have been identified as priorities for An Garda Síochána in
2016: national security and intelligence; national policing;
community safety; and cross-organisation services.
National security and intelligence
The key objective of this priority is to defend the interests of
Ireland in alleviating threats from terrorists by implementing
a number of strategies, such as the International CounterTerrorism Strategy, Cyber Security Strategy, and the joint
Cross-Border Policing Strategy. In addition, the development
of partnerships with policing and security organisations
in Ireland and oversees will enable An Garda Síochána to
contribute to worldwide security. Renewed attention will
be placed on the management of intelligence and will result
in the establishment of intelligence management systems in
units nationwide. In preparation and in alignment with the
framework for major emergency management, a strategy
will be put forward to ensure that Ireland is ready for major
emergencies should they arise. A contribution will also be
made to the National Major Emergency Response Group.
National policing
The overall aim of the Irish policing service is to prevent all
types of crime, for example organised and cross-border
crime, which includes human trafficking, prostitution,
burglary, drug-related crime, white collar crime, and crimes
against business and agriculture. Domestic and sexual
The authors conclude that the content of the SOOCD
campaign reflects the needs of the alcohol industry rather
than public health. They suggest that the main effect of
the campaign may be to protect the reputation of Diageo
in Ireland, while undermining the recent Public Health
(Alcohol) Bill.
The current status of the campaign is unclear. Initially, it was
intended to last for five years; however, social media activity
appears to have ceased, and the SOOCD website is currently
inaccessible (access attempted 20 October 2016).
Deirdre Mongan
1 Ó Fátharta C (2015) Third group steps down from Diageo alcohol
campaign. Irish Examiner 25 Mar 2015. Retrieved 20 October
2016 from http://www.irishexaminer.com/ireland/third-groupsteps-down-from-diageo-alcohol-campaign-320271.html.
2 Petticrew M, Fitzgerald N, Durand MA, Knai C, Davoren M, Perry I
(2016) Diageo’s ‘Stop Out of Control Drinking’ campaign in Ireland:
an analysis. PLoS One, 11(9): e0160379.
violence and crimes against children will continue to
be targeted and investigated by An Garda Síochána.
In order to provide enhanced protection for children,
tools for risk assessment and risk management frameworks
will be developed. This will allow Gardaí to identify the
level of risk to which victims of sexual and domestic
violence are exposed.
With the aim of averting and exposing crime, national anticrime strategies, such as Operation Thor, will continue to
play an important role in reducing crime. The investigation
of crimes will be reinforced by the ongoing development
and implementation of IT systems, such as the major
investigations management system (MIMS).
The intention is to make victims of crime the focus of
policing services, which is in alignment with the EU Directive
on Victims Rights2 and the Criminal Justice (Rights of Victims)
Bill.3 The ability to respond and manage incidents will
therefore be developed by:
•
•
enhancing computer-aided dispatch (CAD)
•
being more efficient in the capture, collation and review
of data collected.
developing strategies in the control room with the aim of
improving service and contact response rates with the
public, and
Interagency collaboration is viewed as an essential
component of addressing and managing repeat offending,
and includes ongoing development of the Garda Juvenile
Diversion Programme, implementation of the Strategic
Approach to Offender Recidivism (SAOR) and the Joint
Agency Response to Crime (J-ARC) initiative.
23
Community safety
Safety on Irish roads is also targeted. Enforcement and
education are viewed as important contributors to increasing
safety on roads and within communities. Recommendations
put forward by the Garda Inspectorate in their report on
fixed charges will result in greater efficiency and more
accountability.4 Additionally, it has been proposed to
implement more automatic number plate recognition (ANPR)
technology, as this will allow Garda to ‘track and target’
offenders (p. 9).
Cross-organisation services
The final objective of the Policing Plan 2016 is to ensure
that resources used in the delivery of a professional policing
and security service are effective and efficient. The main
objectives to be delivered include:
•
Optimising the development and deployment of skills
and human resources across the organisation. This
will include delivery of a Human Resource and People
Development Strategy, revising recruitment, selection
and internal appointment procedures as well as the
identification and implementation of technology suitable
for monitoring performance and development.
•
Developing strong governance and leadership throughout
the organisation. The goal is to develop and implement
a corporate governance framework delineated in
accordance with best practice. Additionally, other
initiatives to be applied include standardised approaches
for the performance and accountability framework (PAF),
the Garda transformation programme, performance
management systems, inspection and review processes,
policy frameworks, and risk management.
•
Instilling a culture of continuous improvement via
education, training, and development. The aim is to
determine how the core vocational and operational
training is to be strategically measured and quantified
with a view to evaluating how they compare with the
current continuous professional development structures
already in place.
Identifying the core functionality of the service in order
to make bureaucratic processes easier and thus moving
towards leaner administrative systems.
•
Working in partnership with the Garda Inspectorate,
Garda Síochána Ombudsman Commission (GSOC) and the
Policing Authority to implement recommendations and
feedback.
•
Addressing effective management of expenditure by
targeting how financial resources are managed to support
policing, fleet investment, and tenders for outsourced
services (e.g. medical, uniforms, construction of two
facilities for evidence and property).
•
Working in partnership with local, national and
international agencies, including academia and agencies,
will increase collaboration resulting in stronger
connections with partner agencies.
Although the Policing Plan 2016 outlines numerous changes
and areas for development, Garda Commissioner Nóirín
O’Sullivan argues that ‘policing [in this way] will be delivered
differently with the aim of providing the country with a world
class police service. But what won’t change is An Garda
Síochána’s unstinting commitment to protecting communities
and this State’ (p. 4).
Ciara H Guiney
1 An Garda Síochána (2016) An Garda Síochana Policing Plan
2016. Available online at http://www.drugsandalcohol.ie/25794/
2 Directive 2012/29/EU of the European Parliament and of the
Council of 25 October 2012 establishing minimum standards
on the rights, support and protection of victims of crime, and
replacing Council Framework Decision 2001/220/JHA. Available
online at http://eur-lex.europa.eu/legal-content/EN/TXT/
PDF/?uri=CELEX:32012L0029&from=EN
3 The Criminal Justice (Victims of Crime) Bill (unpublished). Relevant
Dáil debates available online at http://oireachtasdebates.
oireachtas.ie
4 Garda Inspectorate (2014) Report of the Garda Síochána
Inspectorate: crime investigation. Dublin: Garda Inspectorate.
Available online at http://www.drugsandalcohol.ie/22967/
drugnet IRELAND
The Policing Plan 2016 seeks to build on public safety by
setting out a new community policing framework and a
new crime prevention strategy. The intention is to avail
of ‘local policing fora’ and joint policing committees
(p. 9). Additionally, another priority is to build positive
partnerships with community groups that may be diverse,
at risk or difficult to reach. The aim is for Gardaí to be
more visible within the community, which should result
in greater detection and prevention of public disorder,
antisocial behaviour, and illegal consumption of alcohol
in public places. In order to improve communication, the
Garda Communications Strategy, which aims to improve
communication within the organisation, the State and the
general public, will be implemented.
•
Issue 60 | Winter 2017
An Garda Síochána Policing
Plan 2016 continued
drugnet IRELAND
Issue 60 | Winter 2017
24
Club Health 2017
conference to be
held in Dublin
The 2017 Club Health
International Conference
on Nightlife, Substance Use
and Related Health Issues
will be held in Dublin Castle
from 24 to 26 May 2017.1
This will be the 10th Club
Health conference and the
first to be held in Dublin.
Club Health conferences
bring together experts from a wide range of fields to meet,
present and exchange information on the latest research,
policy and practice on protecting and promoting health
in urban night-time settings, music festivals and holiday
destinations with a clubbing or nightlife focus. Professor
Mark Bellis and Dr Chris Luke, in collaboration with HIT, the
groundbreaking harm-reduction organisation, established
Club Health in Liverpool in 1997. This was in response to the
harm-reduction and health-promotion challenges of that
city’s night-time economy. The first conference was held in
the city’s very popular nightclub, Cream, and was prompted
initially by the health and crime consequences that came
with this popularity.
Global conference
Club Health has grown since 1997 to become a global
conference that attracts a diverse range of expert
international speakers and multidisciplinary participants,
such as academics, researchers, club owners and clubbers.
Club Health conferences have been held biennially since
1997, organised primarily by the Public Health Institute
in Liverpool John Moores University, in partnership with
host organisations, government departments and agencies
in many countries. These include the Netherlands, Italy,
Australia, Slovenia, Spain, the Czech Republic, Switzerland,
the USA and, in 2015, Portugal.
Dublin bid
Following the 2015 Lisbon conference, a small group began
working on a bid for the conference to be hosted in Dublin
City in 2017. Meetings and consultations were held with
key stakeholders to explore the interest and supports
available to plan and deliver a successful conference and
the potential topics and issues it might focus on. Through
these meetings, it emerged strongly that the proposed
conference in Ireland would be timely and welcome; it was
especially pertinent, as the new National Drugs Strategy will
be launched in 2017. Given the range and interdisciplinary of
participants, speakers and topics at previous conferences,
it also resonated with policy developments arising from the
National Sexual Health Strategy2 and results in the 2014 Flash
Eurobarometer survey of young adults aged 15–24 in EU
member states.3 These were in relation to new psychoactive
substances (NPS) consumption and use in Ireland as well as
discussion of the Public Health (Alcohol) Bill 2015. With the
enthusiastic support of stakeholders – such as the Health
Research Board; Dublin City Council; UCD School of Social
Policy, Social Work and Social Justice – and onsite visits to
potential venues, the conference bid was successful, and
awarded to Dublin in March 2016.
The conference in Dublin is expected to attract around 300
participants from across Ireland and the globe. It aims to
build capacity and knowledge among all professionals and
sectors with a stake in a healthy nightlife, including municipal
and state policy-makers, public health planners, medical
and nursing practitioners and scientists, drug and alcohol
addiction service providers, criminologists, local authorities,
transport sector and government agencies, representatives
of the various nightlife industries, and, most importantly,
citizens and customers using or affected by the night-time
economy. The European Monitoring Centre for Drugs and
Drug Addiction (EMCDDA) is a key partner in the Dublin
conference and will be presenting aspects of their current
and relevant research at the event.
Networking is an important feature of all Club Health
conferences. Previous conferences have developed and
enhanced a powerful interdisciplinary international network
of academics and practitioners, resulting in European and
international research and practice collaborations with
further similar alliances expected to emerge from the Dublin
2017 event.
Issues and topics
There will be many significant issues and topics explored in
the conference. These include drug legislation and drug law
reform; emerging trends in club culture; forensic testing of
drugs or ‘pill testing’ and ‘early warning systems’; health and
safety standards for nightlife environments; harm-reduction
interventions in nightlife settings; NPS; nightlife legislation,
policy and economic impact of measures such as ‘lock out
laws’ and night mayors; policing in the nightlife settings and
in nightlife tourism destinations, such as Dublin’s Temple Bar;
sexual health and risk-taking sexual behaviours; violence in
a nightlife context; social exclusion – or nightlife without
money; and other cutting edge and emerging relevant topics.
The Club Health Dublin 2017 conference will be held in the
Printworks in Dublin Castle, 24–26 May. It promises to be
a stimulating, engaging, diverse and comprehensive event,
assessing and debating what works to make the nightlife
environment heathier, economically viable, and safer.
And all this without losing core focus on the essential
fun, dynamic and vibrant elements of a good night out.
The call for abstracts and poster presentations is open via
the Club Health Dublin website, where registration details
and further information on the event and how to participate
can also be found.
Siobhán O’Brien Green
1 For more information on Club Health 2017, visit
http://theclubhealthconference.com/
2 Department of Health (2015) National Sexual Health Strategy
2015–2020 and action plan 2015–2016. Dublin: Department of
Health. http://www.drugsandalcohol.ie/24714/
3 TNS Political & Social (2014) Flash Eurobarometer 401: young
people and drugs. Luxembourg: European Commission.
http://www.drugsandalcohol.ie/22196/
25
3.Supply, access and availability pillar
Aim: To challenge the environment in which alcohol is
made available and accessed.
The Cork and Kerry alcohol strategy 2016–2018: time for
change was launched in June 2016.1 It is the first for the
area and was informed by a literature review of ‘alcohol
and its influence at a global, national and local level’.
This review is published as part of the strategy document.
It includes literature from Ireland, the World Health
Organization, and the European Union. In its conclusion,
it identifies the introduction of minimum unit pricing, a
reduction in availability, and increased restrictions on
advertising and marketing as effective ways of reducing
alcohol-related harms.
Objectives:
• Educate communities in the law regarding sale and
supply of alcohol.
•
Review and challenge the current environment in
which alcohol is available.
4.Screening, treatment and
rehabilitation pillar
Aim: To increase the opportunity for people to access
screening, treatment and rehabilitation services in Cork
and Kerry.
Objectives:
• Inform local communities of drug and alcohol
services.
•
Build the capacity of communities to implement
screening and interventions in their areas.
•
Improve access to drug and alcohol services for local
communities, especially in rural areas.
The strategy sets out its vision statement as ‘motivating the
communities in Cork and Kerry to stop the damage caused
by alcohol’, alongside its mission statement of ‘building
capacity in local communities through an advocacy, research
and evidence based approach to change our relationship
with alcohol’. It has six pillars, each of which has an
overarching aim. Each aim in turn is underpinned by a set of
objectives with defined actions, leads, timeframes, and key
performance indicators.
5.Research pillar
1. Overarching pillar
6.Monitoring and evaluation pillar
Objectives:
• Support the implementation of minimum unit pricing.
Objectives:
• Continually monitor and evaluate the implementation
of actions agreed with the Local Alcohol Action Plan.
Aim: To ensure that all actions are developed and
implemented in the context of relevant national and
local policy.
•
Support the reduction in the availability of alcohol in
local communities.
•
Actively advocate for policy change and
implementation to restrict the marketing of alcoholic
products on a local, regional and national level.
•
Include alcohol in the new national substance misuse
strategy.
2.Education and prevention pillar
Aim 1: To increase the awareness of the impact of alcohol
harm within the wider community.
Aim 2: To increase the general awareness of effective
responses to alcohol harms at local level.
Objectives:
• Actively promote a general awareness of alcohol
harms.
•
Deliver evidence-based education and prevention
programmes across Cork and Kerry.
Aim: To conduct local research to support and underpin
the Local Authority Action Plan.
Objective:
• Conduct research that will inform up-to-date
practice in relation to evidenced-based harm
reduction.
Aim: To monitor and evaluate the implementation of the
Local Alcohol Action Plan to inform ongoing development.
•
Continually monitor and evaluate the impact of our
agreed actions.
Lucy Dillon
1 Cork and Kerry Alcohol Strategy Group (2016) Cork and Kerry
alcohol strategy 2016–2018. Cork: Health Service Executive,
Cork Local Drug & Alcohol Task Force, and Southern Regional
Drug & Alcohol Task Force. http://www.drugsandalcohol.
ie/25693/
drugnet IRELAND
Cork and Kerry
Alcohol Strategy
2016–2018
Issue 60 | Winter 2017
SERVICES
drugnet IRELAND
Issue 60 | Winter 2017
26
National Drugs Library
UPDATES
Overview of the European
university-based study programmes
in the addictions field
‘Trip-sitting’ in the black hole:
a netnographic study of dissociation
and indigenous harm reduction
Recent
publications
Pavlovska A, Miovsky M, Babor T and
Gabrhelik R (2016) Drugs: Education
Prevention and Policy Early online.
http://www.drugsandalcohol.ie/26197/
Hearne E and Van Hout MC (2016)
Journal of Psychoactive Drugs,
48(4): 233-242
http://www.drugsandalcohol.ie/25845/
We mapped and described university
study programmes in the addictions
field (USPA) in Europe, according to
degrees, professional backgrounds,
titles, methods of delivery, duration,
entrance requirements, fees, clinical
practice requirements and courses
offered.
An array of dissociative novel
psychoactive substances, including
‘methoxetamine’, ‘3-MeO-PCP’, and
‘methoxphenidine’, have emerged as
substitutes for the illicit substance
‘ketamine’. A netographic research
methodology aimed to describe
online, dissociative novel psychoactive
substance users’ perceptions of risk,
informed knowledge around use, and
indigenous harm-reduction practices as
advocated within online drug fora, so as
to provide credible information which
can be used to inform public online
health education and drug prevention.
The following abstracts are cited
from published journal articles
recently added to the repository of
the HRB National Drugs Library at
www.drugsandalcohol.ie
Adolescent substance use in the
context of the family: a qualitative
study of young people’s views on
parent-child attachments, parenting
style and parental substance use
McLaughlin A, Campbell A and
McColgan M (2016) Substance Use
& Misuse. 51(14): 1846-1855
http://www.drugsandalcohol.ie/26088/
Adolescent substance use can place
youth at risk of a range of poor
outcomes. This article aimed to explore
risk and protective factors for youth
substance use within the context of
the family with a view to informing
family based interventions. Nine
focus groups supplemented with
participatory techniques were
facilitated with a purposive sample
of sixty-two young people (age 1317 years) from post-primary schools
across Northern Ireland.
Conclusion: Parenting programmes
(tailored to mothers and fathers) may
benefit young people via components
on authoritative styles, parental
monitoring, communication, nurturing
attachments and parent-child conflict.
Youth living with more complex issues,
e.g. parental substance misuse, may
benefit from programmes delivered
beyond the family environment, e.g.
school based settings.
Conclusion: In recent years, the
number of specialised education
programmes that aim to prepare a
new professional workforce has been
growing. The findings provide a basis
for discussion and cooperation among
programmes and universities.
Substance misuse and behavioral
adjustment problems in Irish
adolescents: examining contextual
risk and social proximal factors
Fitzgerald A, Maguire J and
Dooley B (2016) Substance Use
& Misuse, 51(13): 1790-1809
http://www.drugsandalcohol.ie/26022/
Using an ecological perspective to
examine the roles of contextual factors
and proximal social processes, the
current study examined how family,
peer, and school processes mediate
the relationship between cumulative
contextual risk and problem behavior,
and whether these mediating
relationships are moderated by gender.
Conclusion: The study provides
valuable and practical implications
for informing research, interventions,
and social policy at family, peer, and
school levels.
Conclusion: Further research and
consistent monitoring of Internet drug
fora are advised to explore variations
in harm-reduction tactics throughout
dissociative NPS populations, and to
consider how existing harm-reduction
initiatives are influencing these hardto-reach groups.
Attitudes and perceived risk of
cannabis use in Irish adolescents
Barrett P and Bradley C (2016)
Irish Journal of Medical Science,
185(3): 643-647
http://www.drugsandalcohol.ie/25818/
Cannabis is the most widely used illicit
drug in the developed world and its
use is associated with several adverse
physical and mental health effects and
negative social outcomes. Earlier use of
cannabis increases the risk of adverse
effects. Attitudes and perceived risk
towards drugs are regarded as strong
influences in determining whether or not
a person uses cannabis, but there is little
existing research on Irish teenagers’
attitudes to the risks of this drug. This
was a descriptive, cross-sectional
study using a structured, anonymous
questionnaire.
27
Recent publications continued
Alcohol drinking cultures of
European adolescents
Bräker AB and Soellner R (2016)
European Journal of Public Health,
26(4): 581-586
http://www.drugsandalcohol.ie/25801/
Adolescent alcohol use varies across
Europe. Differences in use might be
due to variations in social drinking
norms. These norms become apparent,
e.g. in different proportions of alcohol
drinking types per country. This
study’s purpose is to cluster European
countries according to prevalence
rates of alcohol drinking habits
among adolescents aged 12-16. The
proportions of each drinking pattern
per country (non, mild, episodic,
frequent and heavy episodic use)
across 25 European countries (N=
48,423, M=13.83 years, 48.5% male) are
used as classifying variables.
Conclusion: When applying and
developing intervention strategies,
differences in adolescent alcohol
drinking cultures (i.e. social drinking
norms) within Europe should be
focused on. Alcohol policies and
prevention programs should take
cultural aspects like social drinking
norms into account.
RESPONSES
General practitioners tackle
complex addictions: how complex
interventions can assist in dealing
with addiction
Klimas J (2016) Irish Journal of
Psychological Medicine Early online.
http://www.drugsandalcohol.ie/26034/
Substance use disorder treatment is a
complex problem. Complex problems
require complex interventions, ideally
tested via randomised controlled
trials. Complex interventions are best
developed in stages, using established
implementation frameworks.
Estimating the cost-effectiveness
of brief interventions for heavy
drinking in primary health care
across Europe
Angus C, Thomas C, Anderson P, Meier
PS and Brennan A (2016) European
Journal of Public Health Early online.
http://www.drugsandalcohol.ie/26025/
Screening and Brief Interventions for
alcohol are an effective public health
measure to tackle alcohol-related
harm, however relatively few countries
across the European Union (EU) have
implemented them widely. This may be
due to a lack of understanding of the
specific financial implications of such
policies within each country.
Conclusion: Implementing national
programmes of SBI in primary health
care would be a cost-effective means
of reducing alcohol-attributable
morbidity and deaths in almost all
countries of the EU.
Effectiveness of pharmacotherapies
in increasing treatment retention
and reducing opioid overdose death
in individuals recently released from
prison: a systematic review
Crowley D and Van Hout MC (2016)
Heroin Addiction and Related Clinical
Problems Early online.
http://www.drugsandalcohol.ie/25966/
Opioid dependence is common
amongst the prison population, with
increased risk of fatal overdose in
the immediate post-release period.
The study aimed to review the
effectiveness of pharmacotherapies
(Methadone (METH), Buprenorphine
(BUP), levo-alpha acetyl methadol
(LAAM), Naltrexone (NLT) and Naloxone
(NLX)) in reducing overdose deaths
and increasing treatment retention in
opioid dependent prisoners on release.
Conclusion: The review underscores
the need for prisoners on AOT to be
supported with continued treatment
on release into the community. Further
research is warranted to investigate
potential utility of long-acting NLT
formulations and take-home NLX
(THN) in pre–release opioid
dependent prisoners.
Parenthood, child care, and heroin
use: outcomes after three years
Comiskey CM, Hyland J and
Hyland P (2016) Substance Use &
Misuse, 51(12): 1600-1609
http://www.drugsandalcohol.ie/25951/
Internationally there is a lack of
measurement on the impact of
childcare on people who use
drugs. The aim of this article was
to longitudinally measure drug use,
familial and social status and criminal
involvement between parents and
nonparents who use heroin and have
children in their care.
Conclusion: While caring for children
was associated with reduced heroin
use at 3 years, living with a person who
used at intake removed this effect,
thus indicating that while individual
based addiction theories reflected
observed outcomes, social network
connectedness was more influential.
Variation between hospitals in
inpatient admission practices for
self-harm patients and its impact on
repeat presentation
Carroll R, Corcoran P, Griffin E, Perry I,
Arensman E, Gunnell D and Metcalfe C
(2016) Social Psychiatry and Psychiatric
Epidemiology Early online.
http://www.drugsandalcohol.ie/25875/
Self-harm patient management varies
markedly between hospitals, with
fourfold differences in the proportion
of patients who are admitted to a
medical or psychiatric inpatient bed.
The current study aimed to investigate
whether differences in admission
practices are associated with patient
outcomes (repeat self-harm) while
accounting for differences in patient
case mix.
Conclusion: No strong evidence was
found to suggest medical admission
reduces the risk of repeat self-harm.
Models of health service provision
that encourage prompt mental
health assessment in the emergency
department and avoid unnecessary
medical admission of self-harm
patients appear warranted. Psychiatric
inpatient admission may be associated
with a heightened risk of repeat
self-harm in some patients, but these
findings could be biased by residual
confounding and require replication.
drugnet IRELAND
Conclusion: Cannabis use is very
widespread among teenagers in Cork.
There are relatively low levels of
perceived risk of mental and physical
health problems with use of the
drug. Attitudes towards cannabis are
associated with personal use of the drug
and gender.
Conclusion: Starting with a historical
patient case study, we explore how
treatment of this challenging population
group has been approached, how
an evidence-based framework has
informed formulation of a complex
health intervention and how this has
been progressed via the UK’s Medical
Research Council (MRC) approach.
Issue 60 | Winter 2017
The study was undertaken in nine public
and private secondary schools in Cork
City and suburbs. Students aged 15-18
and in fourth, fifth or sixth year of
school were included.
28
drugnet IRELAND
Issue 60 | Winter 2017
Recent publications continued
Focused interventions for injecting
drug users
Keane M and Hogarthy S (2016) World of
Irish Nursing & Midwifery, 24(5): 66-67
http://www.drugsandalcohol.ie/25820/
The authors discuss the need for
supervised injecting facilities as a
safer alternative to addicts injecting
in public.
The article particularly focuses on what
supervised injecting facilities are and
how injecting facilities operate.
Medical professionals’ perspectives
on prescribed and over-the-counter
medicines containing codeine: a
cross-sectional study
Foley M, Carney T, Rich E, Parry C,
Van Hout MC and Deluca P (2016)
BMJ Open, 6(7): e011725
http://www.drugsandalcohol.ie/25819/
Objectives were to explore prescribing
practitioners’ perspectives on
prescribed codeine use, their
ability to identify dependence and
their options for treatment in the
UK. A cross-sectional design using
a questionnaire was used with a
nationally representative sample of
300 prescribing professionals working
in the UK.
Conclusion: Communication with
patients should involve assessment
of patient understanding of their
medication, including the risk
of dependence. There is a need
to develop extra supports for
professionals including patient
screening tools for identifying codeine
dependence. The support structure for
managing codeine-dependent patients
in primary care requires further
examination.
Effect of integrating HIV and
addiction care for non-engaging
HIV-infected opiate-dependent
patients
Kinahan JC, Surah S, Keating S,
Bergin C, Mulcahy F, Lyons F
and Keenan E (2016) Irish Journal of
Medical Science, 185(3): 623-628
http://www.drugsandalcohol.ie/25816/
HIV-positive substance dependent
patients contribute disproportionally to
HIV morbidity and mortality as a result
of poor compliance with their HIV
treatment. This study aims to establish
if integrating HIV and addiction care
has a significant effect on addiction
and HIV morbidity for non-engaging
HIV-positive opiate-dependent
patients.
Conclusion: Integration of HIV and
addiction care optimises the physical
health of non-engaging HIV-positive
opiate-dependent patients with no
substantial effect on their methadone
maintenance programme.
Determining rates of smoking
cessation advice delivered during
hospitalisation and smoking
cessation rates 3 months post
discharge: a two-hospital survey
Mellon L, McElvaney NG, Cormican
L, Hickey A, Conroy R, Ekpotu L,
Oghenejobo O, Atteih S, McDonnell R
and Doyle F (2016) Health Psychology
and Behavioral Medicine, 4(1): 124-137
http://www.drugsandalcohol.ie/25796/
This study aimed to determine the
prevalence of smoking and cessation
advice received by inpatients in two
teaching hospitals in Ireland, and the
impact of cessation advice on smoking
at 3 months post discharge.
Factors associated with nonretention in HIV care in an era of
widespread antiretroviral therapy
O’Connell S, O’Rourke A,
Sweeney E, Lynam A, Sadlier C and
Bergin C (2016) International Journal
of STD & AIDS Early online
http://www.drugsandalcohol.ie/25952/
In an era of antiretroviral therapy (ART)
for all HIV-1-infected patients, our
primary aim was to describe prevalence
and characteristics of patients
disengaged from care at an urban
ambulatory HIV clinic. We conducted a
nested case-control study. All patients
who disengaged from care (defined
as being lost to follow-up for at least
one year) from 2007 to 2014 inclusive
were identified. Cases were matched
to controls in a 1:4 ratio. A total of 1250
cases were included; 250/2289 (10.9%)
of patients attending our HIV clinic
disengaged from 2007 to 2014. One
hundred and twenty-six (50.4%) were
heterosexual, 81 (32.4%) were men who
have sex with men and 40 (16%) were
intravenous drug users.
Conclusion: On univariate analysis
only, patients with heterosexual risk
were more likely to disengage from
care. Those who disengaged were
younger, mean age of 39. A higher
proportion of patients who disengaged
from care was not receiving ART and
did not have a suppressed HIV-1 viral
load. On multivariable analysis, Irish
patients were less likely to disengage
from HIV care. Factors associated with
non-retention in HIV care have been
identified. A semi-structured interview
of those patients who re-engaged will
take place to further examine reasons
for disengagement from care.
Conclusion: This observational
study finds that provision of brief
cessation advice and smoking status
documentation was suboptimal. Where
advice was given, it was associated
with enhanced motivation to quit and
increased quit rates. These findings,
along with low dependence scores,
suggest that systematic provision of
low-intensity cessation interventions
could significantly enhance quit rates in
hospitalised smokers.
Drugnet Ireland is the quarterly
newsletter of Ireland’s focal
point for the EMCDDA and is
produced in collaboration with
the HRB National Drugs Library.
Drugnet Ireland is published by
the Health Research Board.
Managing editor: Brian Galvin
Copy-editing:
O’Hanlon Media
Production:
Fiona Bannon
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